{"hospital_name":"Uchicago Medicine Adventhealth Hinsdale","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["Uchicago Medicine Adventhealth Hinsdale"],"hospital_address":["120 North Oak St, Hinsdale, IL 60521"],"license_information":{"license_number":"976","state":"IL"},"type_2_npi":["1265465439","1447270780","1093912032"],"attestation":{"attestation":"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","confirm_attestation":true,"attester_name":"Kyle Glass"},"modifier_information":[{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities","code":"TC","modifier_payer_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Preferred PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmBetter","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Access Community Health HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Choice / MCNP POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Duly Health and Care (FKA DMG) HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"SmartHealth Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"VillageMD Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"VillageMD Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Local POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"One Health HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Open Access POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CountyCare Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HFN","plan_name":"20 PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"TriWest","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unicare","plan_name":"HealthLink PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Centene Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]}],"standard_charge_information":[{"description":"PHENOL 1.4 % MT LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"46122026530","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 177 SPRAY"}]},{"description":"LEVETIRACETAM 100 MG/ML PO SOLN BULK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722057447","type":"NDC"}],"standard_charges":[{"gross_charge":1.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"INDOMETHACIN ER 75 MG PO CPCR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722056560","type":"NDC"}],"standard_charges":[{"gross_charge":3.98,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 CAPSULE"}]},{"description":"CITALOPRAM HYDROBROMIDE 10 MG/5ML PO SOLN (NEO/PED)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722056424","type":"NDC"}],"standard_charges":[{"gross_charge":2.98,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"EMTRICITABINE-TENOFOVIR DF 200-300 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722056030","type":"NDC"}],"standard_charges":[{"gross_charge":3.62,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 TABLET"}]},{"description":"ABACAVIR SULFATE 300 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722055760","type":"NDC"}],"standard_charges":[{"gross_charge":4.52,"discounted_cash":1.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 TABLET"}]},{"description":"LOPINAVIR-RITONAVIR 200-50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722055612","type":"NDC"}],"standard_charges":[{"gross_charge":10.90,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 TABLET"}]},{"description":"INDOMETHACIN 50 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722054301","type":"NDC"}],"standard_charges":[{"gross_charge":2.65,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 CAPSULE"}]},{"description":"MARAVIROC 300 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722058060","type":"NDC"}],"standard_charges":[{"gross_charge":24.12,"discounted_cash":6.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 TABLET"}]},{"description":"INDOMETHACIN 25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722054201","type":"NDC"}],"standard_charges":[{"gross_charge":2.92,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 CAPSULE"}]},{"description":"METHOCARBAMOL 750 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722053401","type":"NDC"}],"standard_charges":[{"gross_charge":1.74,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 TABLET"}]},{"description":"METHOCARBAMOL 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722053305","type":"NDC"}],"standard_charges":[{"gross_charge":1.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 TABLET"}]},{"description":"METHOCARBAMOL 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722053301","type":"NDC"}],"standard_charges":[{"gross_charge":1.61,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 TABLET"}]},{"description":"TORSEMIDE 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722053201","type":"NDC"}],"standard_charges":[{"gross_charge":2.78,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 TABLET"}]},{"description":"TORSEMIDE 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722053101","type":"NDC"}],"standard_charges":[{"gross_charge":3.14,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 TABLET"}]},{"description":"TORSEMIDE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722053001","type":"NDC"}],"standard_charges":[{"gross_charge":2.36,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 TABLET"}]},{"description":"TORSEMIDE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722052901","type":"NDC"}],"standard_charges":[{"gross_charge":1.68,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 TABLET"}]},{"description":"LEVETIRACETAM 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722053712","type":"NDC"}],"standard_charges":[{"gross_charge":3.38,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 TABLET"}]},{"description":"NEBIVOLOL HCL 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722058530","type":"NDC"}],"standard_charges":[{"gross_charge":4.04,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 TABLET"}]},{"description":"NEBIVOLOL HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722058630","type":"NDC"}],"standard_charges":[{"gross_charge":2.73,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 TABLET"}]},{"description":"NEBIVOLOL HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722058690","type":"NDC"}],"standard_charges":[{"gross_charge":2.73,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 TABLET"}]},{"description":"ROFLUMILAST 250 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722067632","type":"NDC"}],"standard_charges":[{"gross_charge":6.82,"discounted_cash":1.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 TABLET"}]},{"description":"ROFLUMILAST 250 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722067631","type":"NDC"}],"standard_charges":[{"gross_charge":6.82,"discounted_cash":1.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"TADALAFIL 20 MG PO TABS (WRAPPED)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722064630","type":"NDC"}],"standard_charges":[{"gross_charge":2.70,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 TABLET"}]},{"description":"TADALAFIL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722064430","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 TABLET"}]},{"description":"OSELTAMIVIR PHOSPHATE 75 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722063231","type":"NDC"}],"standard_charges":[{"gross_charge":6.01,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 CAPSULE"}]},{"description":"OSELTAMIVIR PHOSPHATE 45 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722063131","type":"NDC"}],"standard_charges":[{"gross_charge":5.63,"discounted_cash":1.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 CAPSULE"}]},{"description":"OSELTAMIVIR PHOSPHATE 30 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722063031","type":"NDC"}],"standard_charges":[{"gross_charge":5.61,"discounted_cash":1.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 CAPSULE"}]},{"description":"ATOVAQUONE 750 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722062921","type":"NDC"}],"standard_charges":[{"gross_charge":3.65,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 210 ML"}]},{"description":"EZETIMIBE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722062830","type":"NDC"}],"standard_charges":[{"gross_charge":3.11,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 TABLET"}]},{"description":"LACOSAMIDE 10 MG/ML PO SOLN BULK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722062726","type":"NDC"}],"standard_charges":[{"gross_charge":3.72,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"DABIGATRAN ETEXILATE MESYLATE 150 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722062260","type":"NDC"}],"standard_charges":[{"gross_charge":3.93,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 CAPSULE"}]},{"description":"DABIGATRAN ETEXILATE MESYLATE 75 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722062160","type":"NDC"}],"standard_charges":[{"gross_charge":3.92,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 CAPSULE"}]},{"description":"PREGABALIN 25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722061090","type":"NDC"}],"standard_charges":[{"gross_charge":1.97,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 CAPSULE"}]},{"description":"RUFINAMIDE 400 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722059912","type":"NDC"}],"standard_charges":[{"gross_charge":7.96,"discounted_cash":1.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 TABLET"}]},{"description":"RUFINAMIDE 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722059812","type":"NDC"}],"standard_charges":[{"gross_charge":4.54,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 TABLET"}]},{"description":"RITONAVIR 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722059730","type":"NDC"}],"standard_charges":[{"gross_charge":7.02,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 TABLET"}]},{"description":"NEBIVOLOL HCL 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722058830","type":"NDC"}],"standard_charges":[{"gross_charge":4.02,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 TABLET"}]},{"description":"FINASTERIDE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722052530","type":"NDC"}],"standard_charges":[{"gross_charge":1.79,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 TABLET"}]},{"description":"HYDRALAZINE HCL 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722052201","type":"NDC"}],"standard_charges":[{"gross_charge":1.78,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 TABLET"}]},{"description":"HYDRALAZINE HCL 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722052110","type":"NDC"}],"standard_charges":[{"gross_charge":1.69,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 TABLET"}]},{"description":"HYDRALAZINE HCL 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722052101","type":"NDC"}],"standard_charges":[{"gross_charge":1.67,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 TABLET"}]},{"description":"VALSARTAN 160 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722015390","type":"NDC"}],"standard_charges":[{"gross_charge":3.15,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 TABLET"}]},{"description":"VALSARTAN 80 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722015290","type":"NDC"}],"standard_charges":[{"gross_charge":1.76,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 TABLET"}]},{"description":"VALSARTAN 40 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722015130","type":"NDC"}],"standard_charges":[{"gross_charge":2.99,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 TABLET"}]},{"description":"CAPTOPRIL 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"31722014101","type":"NDC"}],"standard_charges":[{"gross_charge":4.86,"discounted_cash":1.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 TABLET"}]},{"description":"BACLOFEN 5 MG PO 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Charge Type: Pharmacy | NDC EA = 96 G"}]},{"description":"MUSCLE RUB 10-15 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"41167000881","type":"NDC"}],"standard_charges":[{"gross_charge":6.36,"discounted_cash":1.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 85 G"}]},{"description":"LIDOCAINE 4 % EX PTCH","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"41167005840","type":"NDC"}],"standard_charges":[{"gross_charge":93.71,"discounted_cash":23.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 PATCH"}]},{"description":"TROLAMINE SALICYLATE 10 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"41167073003","type":"NDC"}],"standard_charges":[{"gross_charge":5.26,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 85 G"}]},{"description":"CAPSAICIN 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"41167075142","type":"NDC"}],"standard_charges":[{"gross_charge":17.77,"discounted_cash":4.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42.5 G"}]},{"description":"CAPSAICIN 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"41167075146","type":"NDC"}],"standard_charges":[{"gross_charge":17.77,"discounted_cash":4.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42.5 G"}]},{"description":"OXYTOCIN 10 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"J2590","type":"HCPCS"},{"code":"42023011683","type":"NDC"}],"standard_charges":[{"gross_charge":63.72,"discounted_cash":15.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 UNITS"}]},{"description":"OXYTOCIN 10 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"J2590","type":"HCPCS"},{"code":"42023011673","type":"NDC"}],"standard_charges":[{"gross_charge":37.42,"discounted_cash":9.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 UNITS"}]},{"description":"OXYTOCIN 10 UNIT/ML IJ 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GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"40565012256","type":"NDC"}],"standard_charges":[{"gross_charge":101.60,"discounted_cash":25.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"}]},{"description":"CADEXOMER IODINE 0.9 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"40565012255","type":"NDC"}],"standard_charges":[{"gross_charge":128.61,"discounted_cash":32.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"}]},{"description":"CADEXOMER IODINE 0.9 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"40565012249","type":"NDC"}],"standard_charges":[{"gross_charge":114.88,"discounted_cash":28.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 G"}]},{"description":"BETA CAROTENE 25000 UNITS PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"40093010599","type":"NDC"}],"standard_charges":[{"gross_charge":1.68,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 CAPSULE"}]},{"description":"VITAMIN D3 125 MCG/0.5ML PO LIQD 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(WRAPPED)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"40985027072","type":"NDC"}],"standard_charges":[{"gross_charge":1.65,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 TABLET"}]},{"description":"TRIMETHOBENZAMIDE HCL 100 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"J3250","type":"HCPCS"},{"code":"42023011925","type":"NDC"}],"standard_charges":[{"gross_charge":212.42,"discounted_cash":53.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"LUTEIN 20 MG PO 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Charge Type: Pharmacy | NDC EA = 28 G"}]},{"description":"HYDROCORTISONE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"41167000210","type":"NDC"}],"standard_charges":[{"gross_charge":14.14,"discounted_cash":3.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 G"}]},{"description":"LANOLIN-PETROLATUM 15.5-53.4 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"41100081163","type":"NDC"}],"standard_charges":[{"gross_charge":6.02,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42.5 G"}]},{"description":"A+D DIAPER RASH EX 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"41100081123","type":"NDC"}],"standard_charges":[{"gross_charge":33.42,"discounted_cash":8.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 G PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"41100080676","type":"NDC"}],"standard_charges":[{"gross_charge":3.95,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 PACKET"}]},{"description":"AZELASTINE HCL 0.15 % NA 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Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"FAMOTIDINE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"46122039475","type":"NDC"}],"standard_charges":[{"gross_charge":1.48,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 TABLET"}]},{"description":"FAMOTIDINE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"46122039465","type":"NDC"}],"standard_charges":[{"gross_charge":1.64,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 TABLET"}]},{"description":"ACETAMINOPHEN 325 MG PO 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Charge Type: Pharmacy | NDC EA = 60 TABLET"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 G PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"46122001452","type":"NDC"}],"standard_charges":[{"gross_charge":3.99,"discounted_cash":1.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 PACKET"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GM/SCOOP PO POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"46122001433","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 238 G"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GM/SCOOP PO 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Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"CARBOXYMETHYLCELLULOSE SOD PF 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"46122075656","type":"NDC"}],"standard_charges":[{"gross_charge":13.63,"discounted_cash":3.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 EACH"}]},{"description":"DICLOFENAC SODIUM 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"46122075253","type":"NDC"}],"standard_charges":[{"gross_charge":6.61,"discounted_cash":1.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 G"}]},{"description":"DICLOFENAC SODIUM 1 % EX 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Type: Pharmacy | NDC EA = 50 G"}]},{"description":"MINERAL OIL-HYDROPHIL PETROLAT EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"46287050816","type":"NDC"}],"standard_charges":[{"gross_charge":4.92,"discounted_cash":1.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 454 G"}]},{"description":"LIDOCAINE 4 % EX PTCH","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"46581083006","type":"NDC"}],"standard_charges":[{"gross_charge":76.64,"discounted_cash":19.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 PATCH"}]},{"description":"CARBIDOPA-LEVODOPA 25-250 MG PO 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Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"IBUPROFEN 100 MG/5ML PO SUSP BULK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"51672138509","type":"NDC"}],"standard_charges":[{"gross_charge":1.76,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"IBUPROFEN 100 MG/5ML PO SUSP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"51672138508","type":"NDC"}],"standard_charges":[{"gross_charge":1.64,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 118 ML"}]},{"description":"MUPIROCIN CALCIUM 2 % EX 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Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"51672131201","type":"NDC"}],"standard_charges":[{"gross_charge":19.38,"discounted_cash":4.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"51672131200","type":"NDC"}],"standard_charges":[{"gross_charge":11.26,"discounted_cash":2.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 G"}]},{"description":"BETAMETHASONE DIPROPIONATE AUG 0.05 % EX 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Pharmacy | NDC EA = 15 G"}]},{"description":"HYDROCORTISONE 1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"51672201802","type":"NDC"}],"standard_charges":[{"gross_charge":7.79,"discounted_cash":1.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 G"}]},{"description":"HYDROCORTISONE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"51672201302","type":"NDC"}],"standard_charges":[{"gross_charge":10.92,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 G"}]},{"description":"HYDROCORTISONE 1 % EX 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51754020304","type":"NDC"}],"standard_charges":[{"gross_charge":65.89,"discounted_cash":16.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"VERAPAMIL HCL 2.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51754020302","type":"NDC"}],"standard_charges":[{"gross_charge":65.93,"discounted_cash":16.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"VERAPAMIL HCL 2.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51754020301","type":"NDC"}],"standard_charges":[{"gross_charge":65.89,"discounted_cash":16.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"TRANEXAMIC ACID-NACL 1000-0.7 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"51754010803","type":"NDC"}],"standard_charges":[{"gross_charge":13.74,"discounted_cash":3.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"TRANEXAMIC ACID-NACL 1000-0.7 MG/100ML-% IV 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Pharmacy | NDC EA = 85 G"}]},{"description":"UREA 40 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0259","type":"RC"},{"code":"54295030815","type":"NDC"}],"standard_charges":[{"gross_charge":100.99,"discounted_cash":25.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.35 G"}]},{"description":"CARBOPLATIN 600 MG/60ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"54288016701","type":"NDC"}],"standard_charges":[{"gross_charge":41.75,"discounted_cash":10.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CARBOPLATIN 450 MG/45ML IV 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System Without Mcc","code_information":[{"code":"002","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":76035.93,"maximum":166276.25,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":144978.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98211.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":121106.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93534.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":151526.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93534.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":112241.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":98802.63},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":85292.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91570.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":117910.79},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93534.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":107565.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76035.93},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":121767.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":96340.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":94637.18},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","code_information":[{"code":"003","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":147868.38,"maximum":323360.29,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271011.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183588.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":235517.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174846.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":283251.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174846.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":209815.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":192143.17},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":165869.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":171174.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":229303.14},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174846.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":201073.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":147868.38},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236803.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":180091.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":184042.56},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","code_information":[{"code":"004","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":97490.79,"maximum":213193.99,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":177076.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119954.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155278.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":114242.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":185073.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":114242.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":137091.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":126681.51},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":109359.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":111843.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":151181.37},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":114242.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":131379.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":97490.79},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":156126.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117670.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":121340.71},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115385.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":114242.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":181742.61},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":199276.83},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":114242.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":213193.99},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":114242.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119954.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":171364.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117670.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":207584.74},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":114242.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":115385.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":114242.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":70989.85,"10th_percentile":70989.85,"90th_percentile":70989.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant With Mcc Or Intestinal Transplant","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":73475.34,"maximum":160676.73,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":131968.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89398.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":117028.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85140.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":137928.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85140.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":102169.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":95475.35},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":82420.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83353.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":113940.02},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85140.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":97912.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":73475.34},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":117667.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87695.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":91450.18},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85992.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85140.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":136972.94},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":150187.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85140.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":160676.73},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85140.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89398.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":127711.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87695.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":156449.23},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":85140.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85992.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85140.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant Without Mcc","code_information":[{"code":"006","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33457.41,"maximum":73165.05,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59693.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40437.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53289.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38511.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62389.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38511.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":46214.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":43475.24},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":37530.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37703.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51883.23},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38511.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44288.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33457.41},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53580.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39667.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":41642.35},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38896.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38511.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":62371.4},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":68388.89},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38511.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":73165.05},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38511.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40437.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57767.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39667.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":71240.04},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":38511.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38896.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38511.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lung Transplant","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":90168.51,"maximum":197181.54,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":165595.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112177.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143616.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106836.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":173074.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106836.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":128203.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":117166.79},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":101145.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104592.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":139826.53},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106836.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":122861.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":90168.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":144400.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110041.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":112227.13},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":107904.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106836.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":168092.4},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":184309.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106836.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":197181.54},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106836.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112177.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":160254.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110041.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":191993.59},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":106836.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107904.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106836.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant","code_information":[{"code":"008","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37541.52,"maximum":82096.23,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72019.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48787.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59794.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46464.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75272.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46464.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":55757.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":48782.21},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":42111.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45488.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58216.56},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46464.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53433.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37541.52},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60120.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47858.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":46725.59},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas Transplant","code_information":[{"code":"010","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55010.94,"maximum":120298.56,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92034.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62345.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87618.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59376.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":96190.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59376.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":71252.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":71482.33},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":61707.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58129.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":85306.82},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59376.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68283.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55010.94},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88097.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61158.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":68468.69},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","code_information":[{"code":"011","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37229.64,"maximum":81414.21,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70102.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47488.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59297.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45227.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":73268.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45227.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":54272.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":48376.95},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":41761.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44277.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":57732.92},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45227.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52011.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37229.64},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59621.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46584.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":46337.41},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28313.46,"maximum":61916.2,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54330.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36804.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45096.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35051.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56783.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35051.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":42062.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":36791.08},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31760.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34315.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43906.38},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35051.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40309.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28313.46},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45342.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36103.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":35240.0},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","code_information":[{"code":"013","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18283.62,"maximum":39982.83,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37333.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25290.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29121.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24086.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39019.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24086.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":28903.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":23758.11},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20509.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23580.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28352.86},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24086.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27699.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18283.62},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29280.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24808.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":22756.48},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allogeneic Bone Marrow Transplant","code_information":[{"code":"014","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":90396.21,"maximum":197679.48,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":153719.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104132.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143978.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99173.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":160661.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99173.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":119008.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":117462.67},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":101400.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97091.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":140179.63},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99173.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":114049.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":90396.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":144764.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102148.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":112510.53},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant With Cc/Mcc","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41644.95,"maximum":91069.66,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76161.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51593.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66330.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49136.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":79600.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49136.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":58963.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":54114.29},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":46714.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48104.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":64579.85},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49136.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56506.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41644.95},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66692.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50610.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":51832.87},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant Without Cc/Mcc","code_information":[{"code":"017","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41644.95,"maximum":91069.66,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69824.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47300.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66330.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45048.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":72978.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45048.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":54057.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":54114.29},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":46714.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44102.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":64579.85},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45048.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51805.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41644.95},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66692.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46399.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":51832.87},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","code_information":[{"code":"018","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":260200.38,"maximum":575603.25,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":550731.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":373076.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":414435.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":355310.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":575603.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":355310.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":426372.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":338109.65},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":291876.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":347849.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":403499.14},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":355310.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":408607.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":260200.38},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416697.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":365969.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":323855.2},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":54694.23,"maximum":119605.98,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91510.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61990.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87114.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59039.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":95643.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59039.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":70846.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":71070.79},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":61352.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57799.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":84815.69},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59039.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67894.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54694.23},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87590.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60810.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":68074.5},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55617.45,"maximum":121624.88,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100863.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68326.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88584.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65073.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":105418.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65073.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":78087.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":72270.44},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":62388.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63706.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":86247.35},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65073.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74834.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55617.45},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89068.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67025.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":69223.57},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65723.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65073.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":103682.21},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":113685.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65073.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":121624.88},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65073.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68326.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":97609.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67025.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":118424.87},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":65073.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65723.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65073.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":387833.61,"10th_percentile":387833.61,"90th_percentile":387833.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","code_information":[{"code":"021","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38138.37,"maximum":83401.43,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68060.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46105.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60745.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43909.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":71134.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43909.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":52691.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":49557.77},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":42781.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42987.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":59142.11},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43909.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50496.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38138.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61076.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45227.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":47468.45},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44349.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43909.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":71097.66},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":77957.04},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43909.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":83401.43},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43909.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46105.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65864.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45227.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":81207.09},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":43909.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44349.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43909.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24359.76,"maximum":53270.21,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41099.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27841.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38799.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26515.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42955.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26515.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":31818.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":31653.57},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27325.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25958.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37775.28},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26515.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30493.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24359.76},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39010.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27311.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":30319.08},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39362.43,"maximum":86078.22,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73620.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49872.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62694.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47497.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76945.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47497.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":56996.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":51148.34},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":44154.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46499.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":61040.29},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47497.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54622.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39362.43},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63036.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48922.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":48991.96},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47972.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47497.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":73379.56},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":80459.09},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47497.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":86078.22},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47497.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49872.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":71246.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48922.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":83813.45},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":47497.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47972.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47497.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34742.21,"10th_percentile":34742.21,"90th_percentile":34742.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","code_information":[{"code":"024","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26229.66,"maximum":57359.32,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50456.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34180.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41777.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32552.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52734.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32552.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":39062.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":34083.35},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":29422.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31868.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40674.98},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32552.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37435.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26229.66},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42005.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33528.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":32646.42},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32877.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32552.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":48897.41},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":53614.95},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32552.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":57359.32},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32552.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34180.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48828.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33528.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":55850.17},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":32552.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32877.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32552.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Mcc","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30856.8,"maximum":67478.01,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58542.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39658.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49147.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37769.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61186.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37769.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":45323.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":40095.95},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":34613.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36976.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47850.4},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37769.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43435.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30856.8},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49415.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38902.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":38405.54},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38147.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37769.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":57523.34},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":63073.09},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37769.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":67478.01},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37769.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39658.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56654.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38902.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":65702.62},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":37769.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38147.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37769.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":86820.24,"10th_percentile":86820.24,"90th_percentile":86820.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35294.48,"10th_percentile":35294.48,"90th_percentile":35294.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35671.15,"10th_percentile":35671.15,"90th_percentile":35671.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Cc","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21102.96,"maximum":46148.2,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40230.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27252.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33611.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25955.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42047.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25955.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":31146.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":27421.61},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23672.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25410.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32724.88},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25955.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29848.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21102.96},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33795.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26733.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":26265.54},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26214.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25955.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":39340.2},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":43135.67},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25955.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46148.2},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25955.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27252.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38932.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26733.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44934.01},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":25955.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26214.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25955.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24755.14,"10th_percentile":24755.14,"90th_percentile":24755.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","code_information":[{"code":"027","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17026.44,"maximum":37233.62,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32761.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22193.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27118.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21136.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34241.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21136.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":25363.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":22124.5},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19099.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20692.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26403.32},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21136.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24307.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17026.44},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27266.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21770.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":21191.75},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21347.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21136.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":31740.74},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":34803.03},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21136.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37233.62},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21136.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22193.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31704.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21770.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36253.98},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":21136.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21347.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21136.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"1 through 10","median_amount":90773.65,"10th_percentile":90773.65,"90th_percentile":90773.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":114281.94,"10th_percentile":114281.94,"90th_percentile":114281.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41945.79,"maximum":91727.54,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77162.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52271.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66809.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49782.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":80647.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49782.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":59738.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":54505.21},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":47052.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48736.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":65046.37},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49782.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57249.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41945.79},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67174.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51275.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":52207.31},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50280.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49782.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":78195.46},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":85739.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49782.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":91727.54},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49782.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52271.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":74673.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51275.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":89314.14},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":49782.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50280.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49782.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"1 through 10","median_amount":227.07,"10th_percentile":227.07,"90th_percentile":227.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Cc Or Spinal Neurostimulators","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23159.85,"maximum":50646.23,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44082.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29862.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36887.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28440.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46073.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28440.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":34128.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":30094.38},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25979.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27843.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35914.55},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28440.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32706.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23159.85},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37089.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29293.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":28825.62},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28724.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28440.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":43174.66},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":47340.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28440.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50646.23},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28440.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29862.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42660.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29293.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49313.7},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":28440.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28724.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28440.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":14808.29,"10th_percentile":14808.29,"90th_percentile":14808.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":70039.0,"10th_percentile":70039.0,"90th_percentile":70039.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures Without Cc/Mcc","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15353.88,"maximum":33576.04,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28587.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19365.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24454.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18443.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29878.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18443.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":22131.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":19951.14},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17223.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18055.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23809.64},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18443.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21209.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15353.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24588.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18996.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":19110.02},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18627.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18443.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":28622.75},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31384.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18443.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33576.04},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18443.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19365.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27664.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18996.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32692.64},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":18443.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18627.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18443.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Mcc","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28913.07,"maximum":63227.44,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57699.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39086.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46051.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37225.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60305.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37225.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":44670.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":37570.23},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":32432.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36443.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44836.21},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37225.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42809.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28913.07},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46302.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38342.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":35986.3},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37597.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37225.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":53899.83},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":59099.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37225.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":63227.44},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37225.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39086.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55838.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38342.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":61563.89},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":37225.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37597.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37225.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":58079.79,"10th_percentile":58079.79,"90th_percentile":58079.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Cc","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14734.95,"maximum":32222.56,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27769.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18811.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23469.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17915.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29023.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17915.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":21498.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":19146.89},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16528.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17539.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22849.85},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17915.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20602.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14734.95},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23597.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18453.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":18339.67},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18094.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17915.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":27468.94},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30119.09},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17915.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32222.56},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17915.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18811.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26873.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18453.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31374.77},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":17915.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18094.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17915.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures Without Cc/Mcc","code_information":[{"code":"033","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11008.26,"maximum":24072.99,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21806.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14771.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17533.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14068.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22790.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14068.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":16882.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14304.36},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12348.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13772.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17070.78},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14068.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16178.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11008.26},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17629.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14490.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13701.3},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14209.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14068.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":20521.63},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22501.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14068.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24072.99},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14068.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14771.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21102.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14490.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23439.62},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":14068.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14209.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14068.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Mcc","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26830.65,"maximum":58673.58,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49931.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33824.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42734.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32213.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52186.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32213.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":38656.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":34864.29},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30096.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31537.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41606.95},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32213.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37045.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26830.65},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42967.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33180.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":33394.44},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32535.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32213.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":50017.78},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":54843.4},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32213.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58673.58},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32213.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33824.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48320.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33180.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":57129.84},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":32213.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32535.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32213.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Cc","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15694.74,"maximum":34321.44,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31074.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21050.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24997.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20048.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32478.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20048.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":24058.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":20394.06},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17605.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19627.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24338.22},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20048.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23055.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15694.74},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25134.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20649.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":19534.26},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20248.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20048.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":29258.18},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":32080.96},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20048.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34321.44},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20048.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21050.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30072.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20649.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33418.42},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":20048.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20248.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20048.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures Without Cc/Mcc","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12647.7,"maximum":27658.14,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25371.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17187.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20144.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16368.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26517.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16368.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":19642.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":16434.68},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14187.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16025.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19613.1},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16368.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18824.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12647.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20254.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16859.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15741.8},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16532.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16368.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":23577.88},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25852.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16368.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27658.14},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16368.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17187.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24553.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16859.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26930.44},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":16368.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16532.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16368.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15312.59,"10th_percentile":15312.59,"90th_percentile":15312.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22912.83,"maximum":50106.04,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42560.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28831.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36494.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27458.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44482.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27458.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":32950.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":29773.4},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25702.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26881.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35531.49},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27458.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31577.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22912.83},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36693.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28282.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":28518.17},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27732.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27458.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":42714.16},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":46835.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27458.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50106.04},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27458.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28831.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41187.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28282.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48787.72},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":27458.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27732.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27458.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Cc","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11116.59,"maximum":24309.89,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21292.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14424.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17705.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13737.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22254.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13737.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":16484.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14445.12},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12469.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13448.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17238.77},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13737.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15797.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11116.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17802.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14149.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13836.13},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13874.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13737.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":20723.58},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22722.95},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13737.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24309.89},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13737.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14424.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20605.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14149.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23670.28},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":13737.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13874.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13737.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12984.68,"10th_percentile":12984.68,"90th_percentile":12984.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures Without Cc/Mcc","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7853.58,"maximum":17174.3,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15596.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10565.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12508.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10062.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16301.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10062.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":12075.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":10205.1},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8809.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9851.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12178.74},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10062.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11571.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7853.58},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12577.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10364.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9774.86},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10163.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10062.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":14640.67},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16053.17},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10062.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17174.3},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10062.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10565.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15093.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10364.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16722.43},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":10062.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10163.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10062.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9407.07,"10th_percentile":9407.07,"90th_percentile":9407.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26025.42,"maximum":56912.69,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49810.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33742.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41452.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32135.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52059.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32135.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":38562.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":33817.96},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":29193.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31460.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40358.26},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32135.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36956.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26025.42},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41678.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33099.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":32392.22},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15584.34,"maximum":34080.02,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28631.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19395.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24822.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18472.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29924.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18472.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":22166.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":20250.61},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17481.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18084.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24167.02},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18472.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21242.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15584.34},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24957.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19026.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":19396.86},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12126.75,"maximum":26518.92,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22631.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15331.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19314.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14600.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23653.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14600.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":17521.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15757.75},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13603.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14294.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18805.25},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14600.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16791.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12126.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19420.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15039.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15093.41},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries With Cc/Mcc","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13885.56,"maximum":30365.1,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23696.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16052.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22116.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15288.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24766.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15288.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18345.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":18043.18},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15575.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14967.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21532.68},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15288.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17581.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13885.56},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22237.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15746.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":17282.49},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6356.97,"maximum":13901.5,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13096.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8871.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10125.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8449.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13687.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8449.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10139.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8260.38},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7130.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8271.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9857.91},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8449.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9716.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6356.97},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10180.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8702.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7912.12},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8533.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8449.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11850.68},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12994.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8449.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13901.5},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8449.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8871.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12673.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8702.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13535.74},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8449.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8533.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8449.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10343.79,"maximum":22619.92,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20073.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13598.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16475.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12950.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20980.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12950.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15540.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13440.93},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11603.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12678.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16040.37},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12950.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14893.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10343.79},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16565.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13339.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12874.27},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13080.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12950.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":19282.92},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21143.31},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12950.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22619.92},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12950.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13598.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19425.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13339.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22024.78},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":12950.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13080.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12950.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":41739.29,"10th_percentile":41739.29,"90th_percentile":138085.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"1 through 10","median_amount":12353.18,"10th_percentile":12353.18,"90th_percentile":12353.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7527.21,"maximum":16460.59,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13610.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9220.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11988.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8781.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14225.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8781.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10537.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9781.01},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8443.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8596.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11672.63},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8781.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10098.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7527.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12054.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9044.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9368.65},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8869.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8781.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":14032.25},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15386.05},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8781.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16460.59},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8781.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9220.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13171.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9044.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16027.5},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8781.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8869.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8781.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17277.6,"maximum":37782.86,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30216.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20469.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27518.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19494.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31580.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19494.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":23393.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":22450.86},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19380.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19085.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26792.8},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19494.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22418.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17277.6},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27669.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20079.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":21504.35},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19689.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19494.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":32208.95},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":35316.42},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19494.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37782.86},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19494.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20469.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29241.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20079.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36788.77},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":19494.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19689.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19494.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9209.43,"maximum":20139.29,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17126.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11602.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14668.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11049.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17900.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11049.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13259.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11966.92},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10330.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10817.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14281.29},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11049.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12707.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9209.43},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14748.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11381.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11462.4},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11160.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11049.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":17168.25},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18824.61},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11049.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20139.29},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11049.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11602.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16574.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11381.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19609.41},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":11049.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11160.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11049.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7507.36,"10th_percentile":7507.36,"90th_percentile":7507.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12735.33,"maximum":27849.77,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22399.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15173.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20284.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14451.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23411.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14451.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":17341.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":16548.55},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14285.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14147.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19748.99},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14451.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16619.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12735.33},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20394.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14884.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15850.87},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14595.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14451.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":23741.24},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26031.75},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14451.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27849.77},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14451.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15173.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21677.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14884.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27117.02},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":14451.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14595.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14451.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Cc","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8442.15,"maximum":18461.39,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16430.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11130.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13446.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10600.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17172.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10600.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":12720.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":10969.9},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9469.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10377.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13091.45},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10600.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12190.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8442.15},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13519.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10918.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10507.42},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10706.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10600.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":15737.88},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17256.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10600.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18461.39},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10600.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11130.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15900.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10918.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17975.66},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":10600.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10706.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10600.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6157.56,"maximum":13465.42,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12339.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8359.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9807.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7961.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12896.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7961.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9553.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8001.26},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6907.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7793.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9548.68},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7961.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9155.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6157.56},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9861.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8199.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7663.93},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8040.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7961.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11478.94},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12586.41},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7961.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13465.42},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7961.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8359.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11941.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8199.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13111.14},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7961.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8040.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7961.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18652.08,"maximum":40788.58,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35745.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24214.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29708.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23061.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37359.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23061.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":27673.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":24236.89},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20922.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22577.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28924.24},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23061.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26520.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18652.08},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29870.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23753.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":23215.08},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","code_information":[{"code":"062","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12287.52,"maximum":26870.49,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23007.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15585.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19570.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14843.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24046.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14843.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":17812.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15966.65},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13783.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14531.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19054.56},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14843.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17069.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12287.52},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19677.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15288.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15293.51},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9692.43,"maximum":21195.52,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18505.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12535.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15437.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11938.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19341.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11938.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":14326.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":12594.54},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10872.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11688.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15030.29},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11938.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13729.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9692.43},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15521.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12297.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12063.56},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12058.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11938.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":18068.66},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19811.89},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11938.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21195.52},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11938.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12535.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17908.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12297.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20637.85},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":11938.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12058.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11938.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13724.79,"maximum":30013.53,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26240.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17775.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21860.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16929.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27425.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16929.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":20315.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":17834.27},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15395.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16573.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21283.37},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16929.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19468.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13724.79},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21979.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17437.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":17082.39},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17098.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16929.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":25585.79},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28054.27},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16929.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30013.53},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16929.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17775.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25394.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17437.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29223.86},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":16929.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17098.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16929.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9987.23,"10th_percentile":9987.23,"90th_percentile":9987.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16027.9,"10th_percentile":16027.9,"90th_percentile":16027.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7017.3,"maximum":15345.51,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13492.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9140.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11176.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8704.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14101.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8704.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10445.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9118.42},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7871.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8522.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10881.9},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8704.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10010.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7017.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11237.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8965.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8734.0},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8791.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8704.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":13081.67},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14343.77},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8704.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15345.51},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8704.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9140.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13057.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8965.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14941.76},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8704.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8791.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8704.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8556.03,"10th_percentile":8556.03,"90th_percentile":8556.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6438.5,"10th_percentile":6438.5,"90th_percentile":6438.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":36509.79,"10th_percentile":36509.79,"90th_percentile":36509.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5646.93,"10th_percentile":5646.93,"90th_percentile":5646.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9049.12,"10th_percentile":9049.12,"90th_percentile":9049.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4749.27,"maximum":10385.76,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9340.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6327.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7564.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6026.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9762.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6026.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7231.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6171.3},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5327.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5899.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7364.81},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6026.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6930.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4749.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7605.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6207.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5911.12},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6086.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6026.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":8853.6},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9707.78},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6026.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10385.76},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6026.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6327.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9039.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6207.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10112.5},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6026.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6086.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6026.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10045.02,"maximum":21966.57,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19332.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13095.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15999.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12472.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20205.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12472.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":14966.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13052.7},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11267.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12210.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15577.06},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12472.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14343.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10045.02},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16086.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12846.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12502.41},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12597.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12472.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":18725.96},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20532.6},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12472.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21966.57},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12472.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13095.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18708.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12846.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21388.61},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":12472.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12597.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12472.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7780.44,"maximum":17014.36,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15031.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10182.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12392.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9697.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15710.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9697.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11637.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":10110.06},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8727.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9494.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12065.32},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9697.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11152.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7780.44},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12459.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9988.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9683.83},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9794.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9697.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":14504.32},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15903.67},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9697.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17014.36},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9697.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10182.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14546.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9988.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16566.7},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":9697.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9794.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9697.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":16588.86,"10th_percentile":16588.86,"90th_percentile":16588.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5417.19,"maximum":12011.46,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11492.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7785.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8628.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7414.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12011.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7414.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8897.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7039.21},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6076.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7258.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8400.57},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7414.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8526.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5417.19},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8675.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7636.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6742.44},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7488.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7414.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":10098.74},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11073.05},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7414.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11846.37},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7414.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7785.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11121.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7636.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11534.69},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7414.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7488.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7414.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11480.22,"maximum":25105.08,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21389.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14489.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18285.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13799.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22355.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13799.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":16559.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14917.63},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12877.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13509.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17802.66},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13799.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15869.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11480.22},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18384.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14213.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14288.71},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13937.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13799.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":21401.46},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23466.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13799.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25105.08},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13799.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14489.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20699.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14213.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24444.55},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":13799.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13937.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13799.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5935.38,"maximum":12979.56,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11338.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7680.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9453.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7315.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11850.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7315.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8778.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7712.55},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6657.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7161.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9204.14},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7315.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8412.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5935.38},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9505.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7534.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7387.4},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4244.19,"maximum":9281.24,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8538.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5783.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6759.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5508.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8923.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5508.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":6610.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":5514.99},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":4760.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5392.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6581.57},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5508.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6334.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4244.19},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6796.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5673.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5282.48},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5563.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5508.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":7912.03},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8675.37},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5508.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9281.24},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5508.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5783.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8262.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5673.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9037.05},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":5508.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5563.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5508.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3515.46,"10th_percentile":3515.46,"90th_percentile":3515.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3515.46,"10th_percentile":3515.46,"90th_percentile":3515.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13043.07,"maximum":28522.74,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23485.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15909.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20774.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15151.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24545.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15151.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18181.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":16948.43},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14630.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14833.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20226.21},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15151.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17424.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13043.07},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20887.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15606.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":16233.9},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15303.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15151.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":24314.93},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26660.79},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15151.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28522.74},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15151.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15909.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22727.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15606.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27772.29},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":15151.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15303.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15151.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6666.78,"maximum":14578.99,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12919.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8751.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10618.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8334.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13502.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8334.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10001.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8662.95},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7478.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8159.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10338.34},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8334.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9585.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6666.78},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10676.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8585.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8297.73},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8418.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8334.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":12428.23},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13627.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8334.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14578.99},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8334.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8751.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12502.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8585.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14195.41},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8334.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8418.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8334.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4847.94,"maximum":10601.53,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9535.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6459.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7721.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6152.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9966.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6152.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7382.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6299.51},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5438.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6022.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7517.82},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6152.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7074.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4847.94},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7763.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6336.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6033.93},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6213.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6152.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":9037.54},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9909.47},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6152.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10601.53},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6152.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6459.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9228.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6336.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10322.6},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6152.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6213.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6152.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11623.05,"maximum":25417.42,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21907.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14840.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18512.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14134.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22897.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14134.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":16960.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15103.23},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13038.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13837.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18024.15},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14134.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16254.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11623.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18613.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14558.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14466.49},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14275.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14134.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":21667.72},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23758.19},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14134.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25417.42},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14134.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14840.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21201.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14558.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24748.67},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":14134.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14275.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14134.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13388.82,"10th_percentile":13388.82,"90th_percentile":13388.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7482.36,"maximum":16362.51,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14563.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9865.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11917.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9396.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15221.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9396.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11275.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9722.73},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8393.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9198.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11603.08},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9396.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10805.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7482.36},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11982.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9677.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9312.83},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9489.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9396.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":13948.64},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15294.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9396.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16362.51},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9396.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9865.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14094.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9677.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15932.0},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":9396.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9489.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9396.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5619.09,"10th_percentile":5619.09,"90th_percentile":5619.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5500.68,"maximum":12028.95,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11161.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7560.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8761.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7200.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11665.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7200.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8640.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7147.7},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6170.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7049.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8530.04},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7200.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8280.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5500.68},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8809.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7416.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6846.35},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7272.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7200.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":10254.38},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11243.71},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7200.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12028.95},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7200.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7560.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10801.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7416.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11712.46},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7200.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7272.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7200.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46258.98,"maximum":101159.67,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85739.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58081.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73679.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55315.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":89611.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55315.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":66379.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":60109.86},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":51890.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54154.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":71734.94},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55315.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63613.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46258.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74081.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56975.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":57575.67},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"448","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28174.08,"maximum":61611.4,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54646.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37018.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44874.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35255.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57113.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35255.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":42306.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":36609.97},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31603.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34515.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43690.24},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35255.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40543.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28174.08},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45119.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36313.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":35066.52},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35532.93,"maximum":77703.82,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68516.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46414.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56595.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44204.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":71610.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44204.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":53044.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":46172.21},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":39858.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43275.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":55101.79},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44204.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50834.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35532.93},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56904.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45530.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":44225.62},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"451","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21292.02,"maximum":46561.64,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41774.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28298.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33912.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26951.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43661.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26951.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":32341.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":27667.28},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23884.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26385.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33018.06},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26951.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30994.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21292.02},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34098.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27759.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":26500.85},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"456","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":58433.34,"maximum":127782.71,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107673.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72940.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93069.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69466.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":112536.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69466.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":83360.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":75929.47},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":65546.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68008.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":90614.02},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69466.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79887.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58433.34},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93578.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71550.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":72728.34},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"457","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39599.1,"maximum":86595.77,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76586.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51881.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63071.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49410.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":80045.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49410.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":59292.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":51455.87},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":44419.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48373.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":61407.3},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49410.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56822.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39599.1},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63415.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50893.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":49286.53},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"458","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29792.13,"maximum":65149.78,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53777.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36429.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47451.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34695.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56205.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34695.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":41634.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":38712.5},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":33419.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33966.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46199.39},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34695.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39899.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29792.13},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47710.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35735.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":37080.41},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","code_information":[{"code":"461","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42343.23,"maximum":92596.67,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70980.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48083.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67442.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45793.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":74185.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45793.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":54952.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":55021.65},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":47498.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44831.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":65662.69},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45793.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52662.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42343.23},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67810.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47167.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":52701.98},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","code_information":[{"code":"462","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19758.84,"maximum":43208.86,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34508.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23376.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31470.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22263.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36066.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22263.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":26715.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":25675.04},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22164.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21795.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30640.52},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22263.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25602.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19758.84},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31642.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22931.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":24592.6},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37264.83,"maximum":81491.16,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73228.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49606.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59353.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47244.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76535.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47244.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":56693.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":48422.68},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":41801.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46252.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":57787.49},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47244.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54330.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37264.83},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59677.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48661.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":46381.21},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20345.34,"maximum":44491.43,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40300.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27300.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32405.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26000.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42120.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26000.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":31200.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":26437.15},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22822.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25454.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31550.02},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26000.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29900.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20345.34},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32582.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26780.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":25322.58},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11977.71,"maximum":26193.0,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23854.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16159.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19077.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15389.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24931.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15389.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18467.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15564.08},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13435.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15066.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18574.13},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15389.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17698.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11977.71},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19181.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15851.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14907.91},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Mcc","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35150.67,"maximum":76867.89,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66934.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45342.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55986.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43183.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69957.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43183.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":51820.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":45675.49},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":39429.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42276.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54509.01},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43183.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49660.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35150.67},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56292.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44478.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":43749.85},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Cc","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23631.81,"maximum":51678.32,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45547.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30854.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37639.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29385.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47604.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29385.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":35262.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":30707.65},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26508.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28768.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36646.43},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29385.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33793.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23631.81},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37845.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30267.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":29413.04},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18100.08,"maximum":39581.46,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35629.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24135.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28828.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22986.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37238.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22986.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":27583.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":23519.61},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20303.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22503.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28068.24},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22986.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26434.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18100.08},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28986.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23676.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":22528.04},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23216.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22986.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":33742.22},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":36997.61},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22986.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39581.46},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22986.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24135.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34479.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23676.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38540.05},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":22986.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23216.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22986.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22552.65,"maximum":49318.4,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39262.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26597.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35920.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25330.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41035.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25330.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":30396.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":29305.37},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25298.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24798.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34972.95},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25330.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29130.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22552.65},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36116.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26090.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":28069.88},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25583.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25330.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":42042.72},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":46098.92},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25330.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49318.4},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25330.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26597.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37995.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26090.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48020.8},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":25330.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25583.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25330.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13009.95,"maximum":28450.31,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25194.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17067.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20721.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16254.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26332.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16254.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":19505.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":16905.39},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14593.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15913.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20174.85},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16254.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18692.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13009.95},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20834.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16742.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":16192.67},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Mcc","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33513.3,"maximum":73287.27,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62135.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42091.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53378.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40087.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64941.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40087.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":48104.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":43547.86},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":37593.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39245.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51969.9},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40087.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46100.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33513.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53669.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41289.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":41711.92},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Cc","code_information":[{"code":"472","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19989.3,"maximum":43712.83,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38152.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25845.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31838.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24614.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39875.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24614.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":29537.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":25974.5},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22422.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24097.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30997.9},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24614.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28306.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19989.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32011.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25353.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":24879.44},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24860.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24614.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":37264.11},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":40859.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24614.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43712.83},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24614.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25845.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36922.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25353.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42562.72},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":24614.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24860.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24614.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"1 through 10","median_amount":35070.67,"10th_percentile":35070.67,"90th_percentile":35070.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cervical Spinal Fusion Without Cc/Mcc","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16333.68,"maximum":35718.68,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31722.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21489.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26015.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20465.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33154.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20465.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":24559.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":21224.32},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18322.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20036.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25329.04},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20465.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23535.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16333.68},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26157.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21079.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":20329.51},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20670.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20465.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":30449.29},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":33386.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20465.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35718.68},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20465.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21489.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30698.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21079.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34778.9},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":20465.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20670.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20465.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30942.36,"maximum":67665.11,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55309.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37467.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49283.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35683.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57807.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35683.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":42820.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":40207.13},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":34709.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34934.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47983.08},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35683.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41036.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30942.36},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49552.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36754.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":38512.03},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14883.99,"maximum":32548.48,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29612.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20060.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23706.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19104.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30949.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19104.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":22925.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":19340.56},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16695.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18703.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23080.97},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19104.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21970.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14883.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23835.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19678.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":18525.17},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12589.05,"maximum":27529.88,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24020.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16271.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20051.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15496.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25104.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15496.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18596.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":16358.47},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14121.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15171.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19522.15},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15496.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17821.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12589.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20160.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15961.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15668.81},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15651.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15496.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":23468.54},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25732.75},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15496.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27529.88},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15496.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16271.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23245.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15961.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26805.55},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":15496.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15651.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15496.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4805.16,"maximum":10507.98,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9698.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6570.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7653.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6257.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10136.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6257.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7508.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6243.92},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5390.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6125.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7451.48},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6257.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7195.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4805.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7695.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6445.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5980.68},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6319.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6257.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":8957.79},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9822.03},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6257.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10507.98},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6257.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6570.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9385.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6445.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10231.51},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6257.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6319.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6257.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7380.93,"maximum":16140.7,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14077.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9536.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11756.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9082.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14712.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9082.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10898.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9590.93},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8279.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8891.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11445.79},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9082.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10444.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7380.93},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11820.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9354.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9186.58},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9172.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9082.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":13759.55},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15087.05},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9082.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16140.7},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9082.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9536.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13623.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9354.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15716.03},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":9082.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9172.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9082.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13517.79,"maximum":29560.86,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25695.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17406.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21530.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16577.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26855.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16577.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":19893.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":17565.29},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15163.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16229.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20962.37},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16577.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19064.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13517.79},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21648.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17074.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":16824.75},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16743.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16577.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":25199.9},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27631.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16577.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29560.86},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16577.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17406.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24866.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17074.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28783.1},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":16577.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16743.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16577.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":110631.9,"10th_percentile":110631.9,"90th_percentile":110631.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","code_information":[{"code":"430","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37743.69,"maximum":82538.34,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74089.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50189.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60116.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47799.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77435.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47799.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":57359.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":49044.92},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":42338.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46796.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58530.07},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47799.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54969.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37743.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60444.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49233.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":46977.22},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","code_information":[{"code":"429","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":57546.0,"maximum":125842.26,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":115396.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78171.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":91656.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74449.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":120607.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74449.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":89339.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":74776.44},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":64551.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72885.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":89238.0},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74449.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":85616.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57546.0},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92157.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76682.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":71623.92},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","code_information":[{"code":"428","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37985.88,"maximum":83067.96,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72241.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48937.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60502.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46607.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75503.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46607.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":55928.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":49359.62},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":42610.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45628.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58905.64},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46607.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53598.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37985.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60832.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48005.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":47278.66},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","code_information":[{"code":"427","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48981.03,"maximum":107112.28,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92580.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62715.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78014.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59729.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":96761.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59729.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":71675.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":63646.94},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":54943.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58475.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":75956.09},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59729.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68688.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48981.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78440.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61521.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":60963.64},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","code_information":[{"code":"426","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":72323.04,"maximum":158156.86,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":141022.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95531.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":115192.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90982.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":147390.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90982.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":109178.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":93978.03},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":81127.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89071.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":112153.12},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90982.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":104629.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":72323.04},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":115821.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93711.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":90015.98},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":91891.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90982.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":134824.82},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":147832.49},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90982.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":158156.86},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90982.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95531.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":136473.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93711.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":153995.67},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":90982.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91891.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90982.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","code_information":[{"code":"425","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10665.33,"maximum":23323.07,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19734.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13368.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16987.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12732.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20625.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12732.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15278.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13858.75},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11963.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12464.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16538.99},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12732.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14641.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10665.33},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17079.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13113.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13274.47},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12859.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12732.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":19882.34},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21800.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12732.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23323.07},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12732.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13368.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19098.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13113.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22709.42},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":12732.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12859.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12732.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","code_information":[{"code":"422","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10138.17,"maximum":22170.27,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18450.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12498.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16147.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11903.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19283.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11903.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":14284.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13173.74},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11372.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11653.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15721.51},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11903.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13689.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10138.17},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16235.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12260.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12618.35},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Cc","code_information":[{"code":"421","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11298.75,"maximum":24708.24,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22756.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15415.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17996.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14681.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23784.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14681.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":17617.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14681.83},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12674.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14373.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17521.25},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14681.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16883.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11298.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18094.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15121.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14062.85},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Mcc","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24351.48,"maximum":53252.1,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44025.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29823.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38785.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28403.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46013.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28403.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":34084.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":31642.81},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27316.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27807.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37762.44},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28403.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32664.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24351.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38997.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29255.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":30308.77},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9091.44,"maximum":19881.27,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18021.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12207.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14480.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11626.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18835.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11626.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13951.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11813.6},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10198.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11382.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14098.32},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11626.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13370.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9091.44},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14559.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11975.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11315.55},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"1 through 10","median_amount":33935.85,"10th_percentile":33935.85,"90th_percentile":33935.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":51812.55,"10th_percentile":51812.55,"90th_percentile":51812.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11443.65,"maximum":25025.11,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22171.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15019.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18226.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14304.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23172.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14304.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":17165.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14870.11},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12836.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14003.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17745.95},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14304.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16449.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11443.65},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18326.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14733.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14243.2},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14447.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14304.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":21333.29},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23391.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14304.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25025.11},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14304.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15019.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21456.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14733.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24366.68},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":14304.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14447.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14304.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11522.54,"10th_percentile":11522.54,"90th_percentile":11522.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16397.85,"maximum":35859.01,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31022.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21015.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26117.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20014.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32423.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20014.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":24017.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":21307.7},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18394.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19594.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25428.55},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20014.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23016.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16397.85},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26260.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20615.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":20409.38},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20214.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20014.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":30568.92},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":33518.16},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20014.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35859.01},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20014.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21015.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30022.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20615.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34915.54},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":20014.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20214.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20014.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9454.38,"maximum":20674.95,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17989.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12186.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15058.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11606.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18801.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11606.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13927.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":12285.21},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10605.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11362.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14661.14},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11606.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13346.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9454.38},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15140.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11954.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11767.28},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13648.2,"maximum":29846.04,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26950.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18256.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21738.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17387.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28167.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17387.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":20864.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":17734.75},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15309.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17022.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21164.6},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17387.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19995.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13648.2},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21856.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17908.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":16987.06},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24174.84,"maximum":52865.82,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46006.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31165.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38504.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29681.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48084.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29681.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":35617.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":31413.28},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27117.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29058.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37488.52},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29681.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34133.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24174.84},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38714.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30572.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":30088.92},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. Without Cc/Mcc","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11470.56,"maximum":25083.95,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21775.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14751.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18269.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14048.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22758.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14048.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":16858.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14905.08},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12866.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13753.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17787.68},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14048.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16155.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11470.56},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18369.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14470.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14276.69},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14189.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14048.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":21383.45},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23446.49},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14048.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25083.95},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14048.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14751.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21073.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14470.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24423.98},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":14048.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14189.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14048.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Cc","code_information":[{"code":"412","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14707.35,"maximum":32162.2,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27406.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18565.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23425.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17681.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28643.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17681.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":21217.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":19111.03},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16497.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17310.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22807.05},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17681.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20333.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14707.35},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23553.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18211.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":18305.32},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17858.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17681.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":27417.48},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30062.68},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17681.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32162.2},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17681.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18565.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26522.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18211.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31316.0},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":17681.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17858.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17681.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Mcc","code_information":[{"code":"411","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18881.16,"maximum":44631.73,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42703.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28927.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30073.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27550.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44631.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27550.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":33060.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":24534.56},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21179.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26971.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29279.48},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27550.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31683.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18881.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30237.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28376.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":23500.2},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27825.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27550.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":35198.31},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":38594.19},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27550.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41289.54},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27550.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28927.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41325.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28376.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40203.19},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":27550.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27825.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27550.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14464.47,"maximum":31631.07,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28358.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19210.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23038.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18296.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29639.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18296.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":21955.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":18795.43},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16225.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17911.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22430.41},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18296.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21040.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14464.47},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23164.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18845.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":18003.02},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","code_information":[{"code":"407","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14735.64,"maximum":32224.07,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28897.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19575.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23470.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18643.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30202.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18643.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":22372.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":19147.79},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16529.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18252.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22850.92},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18643.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21440.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14735.64},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23598.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19203.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":18340.53},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Cc","code_information":[{"code":"406","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19376.58,"maximum":42372.93,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37568.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25449.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30862.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24237.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39264.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24237.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":29084.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":25178.32},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21735.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23728.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30047.74},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24237.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27873.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19376.58},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31030.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24964.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":24116.82},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Mcc","code_information":[{"code":"405","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37455.96,"maximum":81909.13,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70311.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47630.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59658.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45362.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":73486.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45362.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":54434.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":48671.03},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":42015.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44409.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58083.88},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45362.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52166.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37455.96},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59983.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46723.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":46619.1},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","code_information":[{"code":"402","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27111.48,"maximum":59287.7,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51839.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35117.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43181.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33444.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54180.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33444.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":40133.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":35229.21},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30412.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32742.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42042.44},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33444.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38461.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27111.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43417.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34448.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":33743.97},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7756.29,"maximum":16961.54,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15204.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10299.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12353.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9809.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15891.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9809.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11771.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":10078.68},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8700.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9603.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12027.87},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9809.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11280.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7756.29},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12421.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10103.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9653.77},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10441.77,"maximum":22834.18,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19904.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13483.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16631.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12841.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20802.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12841.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15409.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13568.25},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11712.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12571.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16192.31},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12841.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14767.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10441.77},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16721.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13226.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12996.22},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17095.44,"maximum":37384.51,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31131.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21088.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27228.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20084.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32536.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20084.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":24101.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":22214.16},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19176.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19662.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26510.32},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20084.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23097.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17095.44},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27377.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20687.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":21277.63},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4391.16,"maximum":9602.64,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8889.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6022.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6994.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5735.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9291.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5735.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":6882.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":5705.96},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":4925.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5614.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6809.48},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5735.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6595.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4391.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7032.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5907.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5465.4},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5792.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5735.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":8186.01},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8975.79},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5735.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9602.64},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5735.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6022.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8603.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5907.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9349.99},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":5735.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5792.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5735.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6494.97,"maximum":14203.28,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12542.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8496.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10344.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8091.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13108.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8091.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9710.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8439.7},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7285.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7921.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10071.91},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8091.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9305.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6494.97},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10401.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8334.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8083.88},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8172.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8091.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":12107.94},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13276.1},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8091.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14203.28},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8091.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8496.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12137.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8334.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13829.58},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8091.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8172.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8091.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11425.71,"maximum":24985.88,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20995.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14222.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18198.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13545.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21944.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13545.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":16254.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14846.8},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12816.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13261.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17718.13},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13545.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15577.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11425.71},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18297.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13952.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14220.87},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13681.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13545.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":21299.84},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23354.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13545.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24985.88},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13545.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14222.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20318.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13952.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24328.48},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":13545.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13681.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13545.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12669.83,"10th_percentile":12669.83,"90th_percentile":12669.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5384.07,"maximum":11773.95,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10553.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7149.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8575.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6808.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11030.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6808.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8170.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6996.17},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6039.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6665.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8349.21},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6808.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7830.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5384.07},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8622.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7013.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6701.22},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6876.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6808.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":10037.0},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11005.35},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6808.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11773.95},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6808.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7149.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10213.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7013.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11464.17},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6808.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6808.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4689.73,"10th_percentile":4689.73,"90th_percentile":4689.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"1 through 10","median_amount":8567.8,"10th_percentile":8567.8,"90th_percentile":8567.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5308.12,"10th_percentile":5308.12,"90th_percentile":5308.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":18715.79,"10th_percentile":14610.61,"90th_percentile":19972.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8865.81,"maximum":19387.86,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16779.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11366.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14121.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10825.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17536.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10825.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":12990.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11520.41},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9945.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10597.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13748.43},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10825.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12449.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8865.81},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14198.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11150.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11034.72},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10933.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10825.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":16527.67},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18122.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10825.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19387.86},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10825.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11366.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16237.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11150.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18877.75},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":10825.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10933.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10825.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"1 through 10","median_amount":27573.25,"10th_percentile":27573.25,"90th_percentile":27573.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3774.99,"maximum":8255.19,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7552.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5116.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6012.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4872.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7893.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4872.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":5846.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":4905.3},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":4234.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4770.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5853.97},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4872.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5603.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3774.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6045.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5018.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":4698.49},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4921.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4872.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":7037.35},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7716.3},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4872.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8255.19},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4872.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5116.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7308.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5018.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8037.99},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":4872.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4921.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4872.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":15761.55,"10th_percentile":15761.55,"90th_percentile":15761.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5531.73,"maximum":12096.85,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10683.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7237.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8810.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6892.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11166.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6892.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8271.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7188.04},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6205.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6747.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8578.19},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6892.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7926.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5531.73},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8858.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7099.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6885.0},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6961.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6892.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":10312.27},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11307.18},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6892.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12096.85},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6892.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7237.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10338.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7099.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11778.58},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6892.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6961.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6892.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6587.74,"10th_percentile":6587.74,"90th_percentile":6587.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10143.0,"maximum":22180.83,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19435.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13165.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16155.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12538.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20312.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12538.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15046.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13180.02},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11377.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12275.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15729.0},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12538.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14419.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10143.0},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16243.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12915.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12624.36},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12664.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12538.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":18908.61},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20732.88},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12538.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22180.83},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12538.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13165.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18808.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12915.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21597.24},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":12538.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12664.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12538.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4625.07,"maximum":10114.16,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9301.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6300.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7366.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6000.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9721.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6000.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7201.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6009.91},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5188.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5874.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7172.21},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6000.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6900.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4625.07},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7406.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6180.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5756.54},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6847.56,"maximum":14974.32,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13059.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8846.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10906.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8425.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13649.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8425.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10110.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8897.86},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7681.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8248.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10618.68},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8425.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9689.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6847.56},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10966.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8678.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8522.73},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Mcc","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11210.43,"maximum":24515.1,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20779.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14076.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17855.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13405.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21717.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13405.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":16087.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14567.06},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12575.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13124.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17384.29},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13405.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15416.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11210.43},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17952.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13808.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13952.92},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13540.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13405.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":20898.52},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22914.77},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13405.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24515.1},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13405.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14076.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20108.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13808.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23870.09},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":13405.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13540.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13405.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6000.24,"maximum":13121.39,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11511.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7798.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9556.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7426.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12031.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7426.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8912.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7796.83},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6730.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7270.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9304.72},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7426.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8540.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6000.24},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9609.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7649.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7468.12},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7501.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7426.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11185.66},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12264.84},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7426.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13121.39},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7426.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7798.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11140.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7649.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12776.16},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7426.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7501.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7426.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer With Mcc","code_information":[{"code":"383","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8722.98,"maximum":19075.51,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18211.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12336.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13893.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11749.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19033.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11749.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":14098.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11334.82},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9784.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11502.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13526.94},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11749.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13511.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8722.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13969.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12101.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10856.95},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11866.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11749.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":16261.4},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17830.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11749.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19075.51},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11749.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12336.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17623.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12101.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18573.63},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":11749.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11866.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11749.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer Without Cc/Mcc","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5170.17,"maximum":11309.79,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10821.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7330.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8234.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6981.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11309.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6981.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8377.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6718.22},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5799.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6834.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8017.51},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6981.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8028.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5170.17},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8279.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7190.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6434.99},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7051.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6981.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":9638.25},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10568.13},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6981.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11306.19},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6981.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7330.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10472.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7190.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11008.72},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6981.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7051.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6981.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7514.79,"maximum":16433.43,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14424.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9771.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11969.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9306.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15076.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9306.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11167.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9764.87},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8429.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9111.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11653.37},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9306.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10702.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7514.79},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12034.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9585.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9353.19},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9399.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9306.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":14009.09},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15360.67},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9306.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16433.43},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9306.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9771.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13959.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9585.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16001.06},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":9306.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9399.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9306.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13277.67,"maximum":29035.76,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25618.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17354.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21148.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16528.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26775.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16528.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":19833.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":17253.27},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14894.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16181.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20590.01},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16528.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19007.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13277.67},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21263.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17024.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":16525.89},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16693.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16528.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":24752.27},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27140.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16528.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29035.76},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16528.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17354.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24792.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17024.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28271.82},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":16528.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16693.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16528.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4392.54,"maximum":9605.66,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8652.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5861.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6996.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5582.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9043.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5582.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":6699.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":5707.76},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":4927.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5465.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6811.62},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5582.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6419.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4392.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7034.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5750.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5467.12},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5638.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5582.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":8188.59},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8978.61},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5582.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9605.66},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5582.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5861.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8373.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5750.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9352.93},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":5582.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5638.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5582.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6802.71,"maximum":14876.25,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13115.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8884.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10835.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8461.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13707.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8461.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10153.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8839.58},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7630.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8283.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10549.13},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8461.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9730.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6802.71},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10894.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8715.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8466.91},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8546.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8461.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":12681.63},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13905.13},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8461.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14876.25},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8461.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8884.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12692.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8715.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14484.84},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8461.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8546.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8461.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"1 through 10","median_amount":26119.66,"10th_percentile":26119.66,"90th_percentile":26119.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":15366.4,"10th_percentile":15366.4,"90th_percentile":15366.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"1 through 10","median_amount":14880.0,"10th_percentile":14880.0,"90th_percentile":14880.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12544.89,"maximum":27433.31,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23909.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16196.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19980.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15425.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24989.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15425.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18510.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":16301.08},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14072.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15101.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19453.67},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15425.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17739.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12544.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20090.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15888.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15613.84},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15579.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15425.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":23386.22},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25642.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15425.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27433.31},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15425.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16196.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23137.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15888.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26711.53},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":15425.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15579.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15425.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12853.27,"10th_percentile":12853.27,"90th_percentile":12853.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy Without Cc/Mcc","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6092.01,"maximum":13322.08,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12396.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8397.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9703.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7998.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12956.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7998.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9597.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7916.08},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6833.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7830.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9447.03},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7998.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9197.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6092.01},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9756.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8237.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7582.35},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8077.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7998.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11356.74},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12452.42},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7998.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13322.08},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7998.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8397.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11997.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8237.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12971.57},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7998.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8077.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7998.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8478.03,"maximum":18539.85,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16031.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10859.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13503.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10342.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16755.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10342.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":12411.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11016.52},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9510.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10125.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13147.09},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10342.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11894.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8478.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13577.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10653.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10552.08},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10446.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10342.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":15804.77},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17329.58},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10342.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18539.85},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10342.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10859.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15514.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10653.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18052.06},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":10342.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10446.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10342.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Mcc","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14569.35,"maximum":31860.42,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27867.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18877.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23205.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17978.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29125.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17978.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":21574.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":18931.71},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16343.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17601.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22593.05},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17978.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20675.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14569.35},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23332.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18518.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":18133.56},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18158.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17978.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":27160.22},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":29780.6},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17978.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31860.42},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17978.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18877.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26968.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18518.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31022.16},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":17978.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18158.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17978.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5004.57,"maximum":10944.05,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9888.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6698.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7971.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6379.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10335.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6379.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7655.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6503.04},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5613.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6245.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7760.71},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6379.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7336.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5004.57},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8014.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6571.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6228.88},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6443.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6379.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":9329.53},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10229.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6379.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10944.05},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6379.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6698.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9569.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6571.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10656.11},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6379.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6443.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6379.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7102.17,"maximum":15531.11,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13628.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9232.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11312.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8792.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14244.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8792.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10551.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9228.7},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7966.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8608.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11013.51},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8792.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10111.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7102.17},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11373.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9056.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8839.63},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8880.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8792.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":13239.89},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14517.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8792.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15531.11},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8792.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9232.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13189.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9056.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15122.48},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8792.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8880.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8792.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12063.27,"maximum":26380.1,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23209.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15722.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19213.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14974.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24258.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14974.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":17968.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15675.26},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13531.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14659.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18706.81},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14974.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17220.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12063.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19318.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15423.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15014.4},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15123.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14974.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":22488.38},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24658.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14974.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26380.1},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14974.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15722.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22461.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15423.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25686.02},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":14974.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15123.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14974.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders Without Cc/Mcc","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4815.51,"maximum":10530.61,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9549.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6469.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7669.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6161.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9981.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6161.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7393.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6257.37},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5401.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6031.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7467.53},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6161.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7085.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4815.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7711.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6345.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5993.57},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6222.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6161.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":8977.09},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9843.18},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6161.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10530.61},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6161.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6469.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9241.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6345.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10253.55},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6161.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6222.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6161.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7021.44,"maximum":15354.57,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13363.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9052.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11183.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8621.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13967.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8621.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10346.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9123.8},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7876.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8440.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10888.32},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8621.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9915.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7021.44},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11244.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8880.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8739.15},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8708.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8621.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":13089.39},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14352.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8621.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15354.57},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8621.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9052.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12932.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8880.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14950.58},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8621.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8708.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8621.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6366.95,"10th_percentile":6366.95,"90th_percentile":6366.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11522.31,"maximum":25197.12,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20901.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14159.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18352.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13484.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21845.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13484.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":16181.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14972.32},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12925.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13201.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17867.93},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13484.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15507.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11522.31},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18452.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13889.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14341.1},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13619.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13484.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":21479.92},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23552.27},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13484.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25197.12},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13484.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14159.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20227.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13889.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24534.17},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":13484.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13619.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13484.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4593.39,"10th_percentile":4593.39,"90th_percentile":4593.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12644.33,"10th_percentile":12644.33,"90th_percentile":12644.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9349.5,"maximum":20445.6,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18430.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12484.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14891.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11890.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19262.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11890.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":14268.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":12148.93},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10487.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11640.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14498.5},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11890.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13673.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9349.5},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14972.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12247.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11636.74},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12009.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11890.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":17429.37},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19110.92},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11890.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20445.6},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11890.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12484.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17835.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12247.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19907.66},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":11890.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12009.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11890.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Cc","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15538.11,"maximum":33978.92,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30246.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20489.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24748.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19514.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31612.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19514.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":23416.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":20190.54},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17429.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19104.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24095.33},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19514.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22441.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15538.11},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24883.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20099.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":19339.32},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19709.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19514.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":28966.19},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31760.8},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19514.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33978.92},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19514.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20489.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29271.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20099.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33084.91},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":19514.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19709.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19514.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Mcc","code_information":[{"code":"356","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29431.26,"maximum":64360.62,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56582.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38330.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46876.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36504.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59137.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36504.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":43805.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":38243.58},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":33014.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35738.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45639.78},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36504.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41980.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29431.26},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47132.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37599.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":36631.26},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36869.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36504.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":54865.84},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":60159.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36504.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":64360.62},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36504.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38330.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54757.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37599.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":62667.26},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":36504.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36869.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36504.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"1 through 10","median_amount":21243.94,"10th_percentile":21243.94,"90th_percentile":21243.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9198.39,"maximum":20115.15,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17756.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12028.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14650.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11455.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18558.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11455.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13746.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11952.57},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10318.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11215.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14264.17},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11455.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13174.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9198.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14730.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11799.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11448.66},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11570.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11455.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":17147.67},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18802.04},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11455.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20115.15},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11455.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12028.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17183.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11799.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19585.91},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":11455.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11570.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11455.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11737.59,"maximum":25667.9,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22054.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14940.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18695.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14228.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23050.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14228.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":17074.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15252.06},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13166.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13929.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18201.77},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14228.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16362.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11737.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18797.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14655.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14609.05},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14370.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14228.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":21881.25},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23992.31},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14228.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25667.9},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14228.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14940.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21342.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14655.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24992.56},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":14228.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14370.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14228.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32460.36,"maximum":70984.69,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61270.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41505.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51701.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39529.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64037.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39529.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":47435.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":42179.65},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":36412.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38699.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50337.08},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39529.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45458.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32460.36},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51983.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40715.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":40401.39},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39924.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39529.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":60512.7},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":66350.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39529.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":70984.69},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39529.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41505.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59293.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40715.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":69117.04},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":39529.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39924.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39529.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36937.95,"10th_percentile":36937.95,"90th_percentile":36937.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36941.85,"10th_percentile":36941.85,"90th_percentile":36941.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37309.34,"10th_percentile":37309.34,"90th_percentile":37309.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46003.68,"maximum":100601.38,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88240.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59775.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73272.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56929.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":92225.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56929.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":68315.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":59778.12},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":51604.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55733.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":71339.04},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56929.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65468.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46003.68},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73672.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58637.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":57257.91},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57498.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56929.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":85760.19},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":94034.19},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56929.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":100601.38},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56929.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59775.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":85393.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58637.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":97954.5},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":56929.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57498.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56929.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28706.76,"maximum":62776.28,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54421.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36866.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45722.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35110.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56879.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35110.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":42133.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":37302.15},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":32201.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34373.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44516.28},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35110.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40377.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28706.76},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45972.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36164.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":35729.52},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35462.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35110.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":53515.23},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":58678.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35110.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":62776.28},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35110.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36866.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52666.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36164.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":61124.6},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":35110.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35462.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35110.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35416.32,"maximum":77448.82,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67837.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45954.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56409.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43766.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70901.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43766.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":52519.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":46020.68},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":39727.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42846.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54920.96},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43766.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50330.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35416.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56717.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45079.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":44080.49},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44203.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43766.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":66023.21},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":72393.01},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43766.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":77448.82},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43766.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45954.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65649.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45079.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":75411.1},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":43766.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44203.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43766.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40938.71,"10th_percentile":40938.71,"90th_percentile":40938.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23766.36,"maximum":51972.55,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45926.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31111.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37853.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29629.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48000.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29629.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":35555.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":30882.49},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26659.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29007.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36855.08},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29629.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34074.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23766.36},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38060.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30518.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":29580.51},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29926.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29629.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":44305.32},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":48579.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29629.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51972.55},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29629.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31111.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44444.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30518.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50605.12},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":29629.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29926.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29629.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17263.8,"maximum":37752.68,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33145.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22453.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27496.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21383.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34641.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21383.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":25660.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":22432.93},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19365.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20934.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26771.4},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21383.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24591.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17263.8},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27647.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22025.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":21487.18},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21597.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21383.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":32183.23},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":35288.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21383.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37752.68},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21383.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22453.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32075.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22025.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36759.38},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":21383.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21597.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21383.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26979.0,"maximum":58997.99,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53177.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36023.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42970.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34307.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55578.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34307.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":41169.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":35057.06},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30263.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33587.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41837.0},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34307.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39454.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26979.0},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43205.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35337.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":33579.08},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34651.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34307.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":50294.33},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":55146.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34307.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58997.99},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34307.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36023.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51461.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35337.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":57445.72},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":34307.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34651.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34307.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32715.61,"10th_percentile":32715.61,"90th_percentile":32715.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21533.52,"maximum":47089.75,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42555.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28827.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34297.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27455.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44477.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27455.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":32946.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":27981.09},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24154.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26878.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33392.56},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27455.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31573.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21533.52},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34484.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28278.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":26801.43},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27729.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27455.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":40142.85},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":44015.76},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27455.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47089.75},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27455.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28827.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41182.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28278.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45850.79},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":27455.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27729.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27455.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51719.89,"10th_percentile":51719.89,"90th_percentile":51719.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":72922.52,"10th_percentile":72922.52,"90th_percentile":72922.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25919.45,"10th_percentile":25919.45,"90th_percentile":25925.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48758.85,"maximum":106626.42,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91456.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61954.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77660.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59004.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":95587.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59004.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":70805.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":63358.24},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":54694.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57765.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":75611.55},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59004.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67855.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48758.85},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78084.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60774.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":60687.1},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42738.6,"maximum":93461.27,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77140.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52256.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68072.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49768.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":80624.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49768.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":59721.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":55535.4},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":47941.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48723.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":66275.8},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49768.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57233.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42738.6},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68443.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51261.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":53194.07},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Mcc","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32100.18,"maximum":70197.05,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59457.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40277.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51127.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38359.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62142.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38359.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":46031.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":41711.63},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":36008.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37554.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49778.54},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38359.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44113.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32100.18},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51406.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39510.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":39953.09},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34520.01,"maximum":75488.76,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71530.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48456.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54981.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46148.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":74760.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46148.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":55378.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":44856.0},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":38722.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45179.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53531.03},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46148.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53070.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34520.01},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55282.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47533.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":42964.91},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22108.98,"maximum":48667.33,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46564.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31543.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35214.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30041.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48667.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30041.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":36049.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":28728.86},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24800.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29410.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34284.94},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30041.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34547.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22108.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35406.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30942.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":27517.67},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11326.35,"maximum":24768.59,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21056.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14264.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18040.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13585.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22007.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13585.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":16302.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14717.69},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12705.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13299.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17564.05},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13585.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15622.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11326.35},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18138.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13992.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14097.2},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13720.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13585.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":21114.61},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23151.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13585.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24768.59},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13585.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14264.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20377.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13992.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24116.92},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":13585.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13720.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13585.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12706.68,"10th_percentile":12706.68,"90th_percentile":12706.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7523.01,"10th_percentile":7523.01,"90th_percentile":7523.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6360.42,"maximum":13909.04,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12330.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8353.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10130.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7955.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12887.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7955.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9546.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8264.86},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7134.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7788.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9863.26},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7955.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9148.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6360.42},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10185.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8193.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7916.42},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8034.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7955.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11857.11},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13001.07},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7955.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13909.04},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7955.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8353.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11932.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8193.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13543.09},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7955.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8034.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7955.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"1 through 10","median_amount":19457.0,"10th_percentile":19457.0,"90th_percentile":19457.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5003.19,"maximum":10941.03,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9833.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6661.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7968.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6344.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10277.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6344.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7613.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6501.25},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5612.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6211.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7758.57},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6344.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7296.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5003.19},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8012.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6534.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6227.16},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6407.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6344.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":9326.96},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10226.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6344.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10941.03},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6344.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6661.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9516.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6534.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10653.17},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6344.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6344.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13492.26,"maximum":29505.03,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25855.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17515.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21489.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16681.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27023.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16681.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":20017.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":17532.12},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15134.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16330.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20922.78},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16681.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19183.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13492.26},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21607.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17181.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":16792.98},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16847.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16681.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":25152.31},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27578.96},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16681.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29505.03},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16681.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17515.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25021.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17181.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28728.74},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":16681.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16847.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16681.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5112.21,"maximum":11179.44,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9440.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6394.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8142.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6090.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9866.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6090.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7308.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6642.91},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5734.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5962.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7927.63},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6090.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7004.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5112.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8186.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6273.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6362.85},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6151.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6090.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":9530.2},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10449.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6090.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11179.44},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6090.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6394.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9135.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6273.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10885.3},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6090.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6151.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6090.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired Without Cc/Mcc","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3872.97,"maximum":8624.28,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8251.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5589.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6168.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5323.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8624.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5323.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":6388.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":5032.62},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":4344.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5211.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6005.91},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5323.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6122.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3872.97},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6202.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5483.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":4820.44},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5376.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5323.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":7220.0},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7916.58},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5323.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8469.46},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5323.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5589.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7985.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5483.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8246.62},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":5323.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5376.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5323.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15271.77,"maximum":33396.48,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28811.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19517.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24324.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18587.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30112.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18587.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":22305.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":19844.45},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17130.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18197.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23682.31},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18587.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21376.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15271.77},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24456.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19145.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":19007.82},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18773.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18587.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":28469.68},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31216.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18587.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33396.48},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18587.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19517.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27881.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19145.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32517.8},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":18587.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18773.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18587.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":22800.11,"10th_percentile":22800.11,"90th_percentile":22800.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11598.2,"10th_percentile":11598.2,"90th_percentile":11598.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7518.24,"maximum":16440.97,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14254.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9656.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11974.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9196.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14898.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9196.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11035.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9769.35},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8433.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9003.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11658.72},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9196.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10575.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7518.24},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12040.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9472.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9357.48},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9288.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9196.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":14015.52},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15367.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9196.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16440.97},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9196.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9656.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13794.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9472.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16008.4},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":9196.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9288.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9196.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":25367.19,"10th_percentile":25367.19,"90th_percentile":25367.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18845.97,"maximum":41212.59,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35096.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23775.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30016.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22643.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36681.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22643.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":27171.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":24488.84},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21140.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22167.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29224.91},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22643.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26039.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18845.97},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30180.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23322.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":23456.4},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22869.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22643.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":35132.71},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":38522.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22643.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41212.59},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22643.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23775.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33964.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23322.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40128.26},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":22643.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22869.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22643.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Cc","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10878.54,"maximum":23789.32,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22366.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15151.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17326.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14430.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23376.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14430.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":17316.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14135.8},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12202.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14126.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16869.62},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14430.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16594.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10878.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17421.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14862.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13539.84},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14574.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14430.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":20279.81},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22236.37},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14430.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23789.32},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14430.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15151.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21645.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14862.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23163.41},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":14430.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14574.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14430.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis Without Cc/Mcc","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6755.1,"maximum":14772.13,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12465.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8444.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10759.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8042.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13028.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8042.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9650.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8777.71},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7577.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7873.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10475.3},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8042.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9248.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6755.1},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10817.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8283.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8407.65},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9003.81,"maximum":19689.64,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16976.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11500.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14340.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10952.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17743.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10952.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13143.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11699.73},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10099.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10722.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13962.43},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10952.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12595.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9003.81},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14419.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11281.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11206.48},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11062.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10952.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":16784.93},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18404.31},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10952.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19689.64},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10952.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11500.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16428.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11281.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19171.59},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":10952.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11062.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10952.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6464.66,"10th_percentile":6464.66,"90th_percentile":6464.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10248.02,"10th_percentile":10248.02,"90th_percentile":10248.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6276.37,"10th_percentile":6276.37,"90th_percentile":6276.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":37660.89,"10th_percentile":37660.89,"90th_percentile":37660.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10248.02,"10th_percentile":10248.02,"90th_percentile":10281.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10387.7,"10th_percentile":10387.7,"90th_percentile":10387.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5942.97,"maximum":12996.16,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11437.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7748.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9465.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7379.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11954.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7379.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8854.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7722.42},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6666.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7224.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9215.91},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7379.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8486.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5942.97},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9517.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7600.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7396.84},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7452.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7379.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11078.9},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12147.78},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7379.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12996.16},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7379.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7748.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11068.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7600.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12654.22},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7379.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7452.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7379.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3788.1,"maximum":8283.86,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7832.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5305.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6033.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5053.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8186.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5053.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":6063.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":4922.33},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":4249.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4947.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5874.3},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5053.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5811.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3788.1},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6066.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5204.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":4714.81},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5103.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5053.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":7061.79},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7743.1},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5053.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8283.86},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5053.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5305.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7579.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5204.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8065.91},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":5053.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5103.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5053.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4834.77,"10th_percentile":4834.77,"90th_percentile":4834.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis With Cc/Mcc","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8472.51,"maximum":18527.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13494.62},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11009.35},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9503.95},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13138.53},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8472.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13568.3},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10545.21},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":15794.48},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17318.3},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18527.78},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18040.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis Without Cc/Mcc","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5449.62,"maximum":11917.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8679.9},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7081.35},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6113.05},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8450.86},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5449.62},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8727.29},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6782.8},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":10159.2},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11139.34},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11917.29},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11603.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11304.27,"maximum":24720.31,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20519.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13900.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18004.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13238.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21446.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13238.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15885.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14689.0},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12680.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12960.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17529.81},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13238.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15224.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11304.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18103.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13635.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14069.72},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13370.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13238.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":21073.45},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23106.58},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13238.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24720.31},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13238.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13900.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19857.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13635.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24069.9},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":13238.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13370.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13238.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Cc","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4860.36,"maximum":10628.69,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8698.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5892.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7741.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5612.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9091.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5612.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":6734.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6315.65},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5452.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5494.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7537.08},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5612.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6453.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4860.36},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7783.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5780.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6049.39},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5668.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5612.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":9060.7},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9934.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5612.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10628.69},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5612.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5892.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8418.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5780.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10349.04},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":5612.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5668.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5612.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained Without Cc/Mcc","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3047.04,"maximum":6709.67,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6419.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4348.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4853.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4141.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6709.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4141.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":4970.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":3959.39},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":3417.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4054.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":4725.12},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4141.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":4763.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3047.04},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4879.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4266.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":3792.46},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11162.13,"maximum":24409.48,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21421.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14511.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17778.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13820.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22388.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13820.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":16584.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14504.3},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12521.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13529.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17309.39},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13820.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15893.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11162.13},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17875.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14234.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13892.81},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13958.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13820.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":20808.48},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22816.04},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13820.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24409.48},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13820.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14511.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20730.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14234.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23767.25},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":13820.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13958.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13820.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7386.45,"maximum":16152.77,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14221.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9633.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11764.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9174.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14863.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9174.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11009.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9598.1},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8285.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8982.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11454.35},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9174.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10551.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7386.45},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11829.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9450.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9193.45},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9266.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9174.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":13769.84},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15098.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9174.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16152.77},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9174.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9633.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13762.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9450.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15727.79},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":9174.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9266.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9174.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4921.77,"maximum":10762.98,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9790.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6632.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7839.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6316.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10232.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6316.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7579.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6395.45},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5520.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6183.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7632.31},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6316.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7263.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4921.77},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7881.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6505.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6125.82},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6379.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6316.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":9175.18},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10060.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6316.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10762.98},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6316.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6632.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9474.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6505.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10479.8},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6316.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6379.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6316.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8026.08,"maximum":17551.52,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15865.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10747.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12783.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10235.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16582.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10235.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":12283.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":10429.25},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9003.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10021.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12446.24},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10235.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11771.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8026.08},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12853.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10543.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9989.56},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10338.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10235.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":14962.24},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16405.77},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10235.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17551.52},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10235.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10747.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15353.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10543.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17089.73},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":10235.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10338.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10235.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4639.56,"maximum":10145.84,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9198.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6230.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7389.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5934.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9613.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5934.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7121.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6028.74},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5204.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5809.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7194.68},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5934.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6824.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4639.56},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7430.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6112.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5774.57},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5993.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5934.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":8649.08},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9483.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5934.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10145.84},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5934.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6230.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8901.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6112.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9878.9},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":5934.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5993.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5934.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":12699.33,"10th_percentile":12699.33,"90th_percentile":12699.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8106.12,"maximum":17726.56,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15781.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10690.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12911.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10181.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16494.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10181.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":12218.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":10533.26},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9092.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9967.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12570.36},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10181.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11709.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8106.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12981.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10487.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10089.18},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10283.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10181.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":15111.45},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16569.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10181.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17726.56},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10181.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10690.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15272.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10487.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17260.16},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":10181.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10283.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10181.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5179.83,"maximum":11327.31,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10241.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6937.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8250.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6607.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10703.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6607.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7928.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6730.78},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5810.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6468.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8032.49},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6607.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7598.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5179.83},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8295.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6805.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6447.01},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6673.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6607.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":9656.25},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10587.87},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6607.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11327.31},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6607.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6937.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9911.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6805.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11029.28},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6607.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6673.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6607.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":31281.27,"10th_percentile":31281.27,"90th_percentile":31281.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5939.77,"10th_percentile":5939.77,"90th_percentile":5939.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":285.7,"10th_percentile":285.7,"90th_percentile":285.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10332.06,"maximum":22594.27,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20696.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14020.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16456.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13352.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21631.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13352.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":16023.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13425.69},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11589.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13072.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16022.18},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13352.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15355.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10332.06},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16546.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13753.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12859.67},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13486.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13352.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":19261.06},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21119.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13352.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22594.27},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13352.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14020.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20028.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13753.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21999.8},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":13352.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13486.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13352.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Mcc","code_information":[{"code":"353","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20236.32,"maximum":44253.02,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37591.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25464.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32231.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24252.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39288.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24252.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":29102.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":26295.48},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22699.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23742.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31380.96},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24252.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27890.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20236.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32407.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24979.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":25186.89},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7607.25,"maximum":16635.62,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15498.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10499.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12116.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9999.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16198.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9999.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11999.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9885.02},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8533.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9789.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11796.75},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9999.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11499.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7607.25},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12182.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10299.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9468.27},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Cc","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10382.43,"maximum":22704.42,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20042.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13577.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16536.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12930.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20948.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12930.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15517.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13491.14},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11646.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12659.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16100.29},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12930.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14870.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10382.43},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16626.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13318.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12922.36},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13060.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12930.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":19354.96},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21222.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12930.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22704.42},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12930.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13577.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19396.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13318.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22107.05},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":12930.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13060.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12930.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12122.87,"10th_percentile":12122.87,"90th_percentile":12122.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Mcc","code_information":[{"code":"350","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16696.62,"maximum":36512.36,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32366.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21925.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26593.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20881.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33828.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20881.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":25058.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":21695.93},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18729.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25891.86},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20881.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24014.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16696.62},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26738.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21508.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":20781.24},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21090.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20881.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":31125.89},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":34128.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20881.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36512.36},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20881.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21925.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31322.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21508.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35551.7},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":20881.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21090.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20881.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures Without Cc/Mcc","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6078.21,"maximum":13291.9,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11712.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7934.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9681.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7556.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12241.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7556.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9068.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7898.15},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6818.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7397.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9425.63},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7556.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8690.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6078.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9733.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7783.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7565.17},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7632.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7556.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11331.02},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12424.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7556.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13291.9},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7556.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7934.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11335.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7783.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12942.18},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7556.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7632.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7556.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Cc","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8685.72,"maximum":18994.03,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17295.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11716.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13834.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11158.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18076.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11158.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13389.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11286.4},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9743.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10923.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13469.16},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11158.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12831.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8685.72},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13909.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11492.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10810.57},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11269.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11158.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":16191.94},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17754.12},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11158.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18994.03},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11158.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11716.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16737.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11492.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18494.29},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":11158.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11269.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11158.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Mcc","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16329.54,"maximum":35709.63,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29866.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20231.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26008.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19268.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31214.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19268.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":23122.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":21218.94},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18317.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18863.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25322.62},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19268.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22158.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16329.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26150.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19846.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":20324.36},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19461.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19268.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":30441.58},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":33378.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19268.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35709.63},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19268.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20231.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28902.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19846.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34770.09},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":19268.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19461.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19268.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8591.88,"maximum":18788.82,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15733.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10658.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13684.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10150.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16443.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10150.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":12180.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11164.46},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9637.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9937.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13323.64},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10150.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11673.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8591.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13759.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10455.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10693.78},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10252.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10150.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":16017.01},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17562.3},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10150.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18788.82},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10150.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10658.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15225.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10455.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18294.48},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":10150.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10252.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10150.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":30014.07,"10th_percentile":30014.07,"90th_percentile":30014.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Cc","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10275.48,"maximum":22470.54,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19790.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13406.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16366.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12768.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20684.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12768.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15321.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13352.17},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11526.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12500.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15934.44},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12768.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14683.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10275.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16455.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13151.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12789.25},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12895.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12768.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":19155.58},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21003.68},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12768.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22470.54},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12768.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13406.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19152.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13151.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21879.33},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":12768.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12895.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12768.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Mcc","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18591.36,"maximum":40655.8,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33524.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22710.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29611.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21628.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35038.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21628.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":25954.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":24157.99},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20854.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21174.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28830.08},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21628.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24873.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18591.36},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29773.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22277.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":23139.51},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21845.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21628.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":34658.07},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":38001.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21628.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40655.8},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21628.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22710.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32443.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22277.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39586.12},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":21628.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21845.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21628.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10591.5,"maximum":23161.62,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20176.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13668.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16869.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13017.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21087.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13017.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15620.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13762.81},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11880.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12743.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16424.5},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13017.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14969.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10591.5},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16961.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13182.58},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13147.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13017.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":19744.71},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21649.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13017.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23161.62},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13017.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13668.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19525.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22552.22},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":13017.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13147.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13017.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14575.56,"maximum":31874.0,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27485.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18618.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23215.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17732.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28726.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17732.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":21278.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":18939.78},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16349.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17359.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22602.68},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17732.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20392.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14575.56},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23342.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18264.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":18141.29},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17909.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17732.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":27171.8},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":29793.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17732.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31874.0},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17732.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18618.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26598.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18264.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31035.38},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":17732.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17909.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17732.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25004.91,"maximum":54681.03,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46112.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31237.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39826.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29749.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48194.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29749.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":35699.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":32491.89},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28048.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29125.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38775.73},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29749.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34212.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25004.91},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40044.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30642.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":31122.05},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30047.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29749.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":46614.23},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":51111.49},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29749.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54681.03},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29749.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31237.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44624.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30642.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53242.34},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":29749.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30047.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29749.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection Without Cc/Mcc","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11442.96,"maximum":25023.6,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21487.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14556.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18225.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13862.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22457.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13862.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":16635.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14869.21},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12836.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13571.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17744.88},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13862.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15942.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11442.96},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18325.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14278.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14242.34},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14001.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13862.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":21332.0},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23390.07},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13862.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25023.6},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13862.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14556.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20794.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14278.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24365.21},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":13862.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14001.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13862.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Cc","code_information":[{"code":"333","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14663.19,"maximum":32065.63,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30459.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20633.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23354.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19651.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31835.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19651.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":23581.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":19053.65},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16448.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19238.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22738.57},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19651.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22599.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14663.19},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23482.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20240.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":18250.36},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19847.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19651.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":27335.16},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":29972.41},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19651.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32065.63},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19651.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20633.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29477.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20240.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31221.97},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":19651.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19847.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19651.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Mcc","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23932.65,"maximum":52336.2,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46746.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31667.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38118.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30159.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48857.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30159.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":36190.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":31098.57},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26846.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29525.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37112.95},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30159.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34682.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23932.65},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38326.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31063.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":29787.48},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30460.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30159.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":44615.32},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":48919.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30159.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52336.2},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30159.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31667.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45238.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31063.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50959.2},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":30159.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30460.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30159.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11391.9,"maximum":24911.94,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22060.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14944.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18144.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14232.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23057.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14232.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":17079.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14802.87},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12778.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13933.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17665.7},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14232.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16367.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11391.9},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18243.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14659.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14178.79},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14375.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14232.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":21236.81},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23285.7},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14232.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24911.94},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14232.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14944.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21349.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14659.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24256.49},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":14232.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14375.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14232.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16309.53,"maximum":35665.87,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31160.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21108.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25977.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20103.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32567.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20103.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":24124.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":21192.93},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18295.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19681.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25291.59},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20103.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23118.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16309.53},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26118.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20706.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":20299.46},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20304.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20103.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":30404.27},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":33337.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20103.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35665.87},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20103.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21108.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30155.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20706.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34727.48},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":20103.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20304.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20103.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"1 through 10","median_amount":26345.23,"10th_percentile":26345.23,"90th_percentile":26345.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"1 through 10","median_amount":9920.0,"10th_percentile":9920.0,"90th_percentile":9920.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31682.73,"maximum":69284.16,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59177.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40087.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50462.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38178.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61849.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38178.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":45814.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":41169.18},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":35539.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37377.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49131.19},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38178.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43905.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31682.73},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50738.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39324.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":39433.52},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38560.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38178.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":59063.04},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":64761.34},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38178.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":69284.16},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38178.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40087.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57268.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39324.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":67461.26},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":38178.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38560.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38178.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":50059.48,"10th_percentile":50059.48,"90th_percentile":50059.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35700.74,"10th_percentile":35700.74,"90th_percentile":35700.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10994.46,"maximum":24042.81,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21034.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14248.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17511.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13570.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21983.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13570.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":16284.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14286.42},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12332.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13285.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17049.38},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13570.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15605.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10994.46},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17607.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13977.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13684.12},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13706.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13570.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":20495.9},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22473.31},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13570.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24042.81},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13570.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14248.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20355.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13977.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23410.23},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":13570.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13706.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13570.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16753.89,"maximum":36637.6,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31759.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21514.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26684.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20489.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33193.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20489.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":24587.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":21770.34},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18793.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20059.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25980.67},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20489.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23563.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16753.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26830.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21104.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":20852.52},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35043.03,"maximum":76632.5,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64157.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43461.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55814.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41391.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":67054.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41391.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":49670.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":45535.62},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":39309.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40522.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54342.09},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41391.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47600.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35043.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56119.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42633.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":43615.88},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy Without Intraluminal Device","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19747.8,"maximum":43394.83,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41519.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28126.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31453.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26786.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43394.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26786.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":32144.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":25660.69},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22151.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26224.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30623.4},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26786.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30804.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19747.8},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31625.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27590.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":24578.86},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22045.5,"maximum":48209.36,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40763.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27613.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35113.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26298.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42603.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26298.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":31558.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":28646.37},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24729.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25746.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34186.5},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26298.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30243.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22045.5},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35304.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27087.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":27438.66},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29388.48,"maximum":64267.07,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55749.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37765.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46808.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35967.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58267.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35967.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":43160.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":38187.99},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":32966.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35211.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45573.44},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35967.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41362.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29388.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47064.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37046.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":36578.01},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36326.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35967.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":54786.09},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":60071.76},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35967.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":64267.07},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35967.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37765.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53950.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37046.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":62576.17},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":35967.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36326.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35967.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12482.79,"maximum":27297.51,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23081.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15635.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19882.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14891.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24123.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14891.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":17869.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":16220.39},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14002.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14578.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19357.37},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14891.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17124.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12482.79},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19990.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15337.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15536.55},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15040.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14891.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":23270.45},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25515.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14891.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27297.51},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14891.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15635.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22336.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15337.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26579.3},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":14891.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15040.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14891.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"1 through 10","median_amount":57114.39,"10th_percentile":57114.39,"90th_percentile":57114.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":13462.78,"10th_percentile":13462.78,"90th_percentile":13462.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"1 through 10","median_amount":24462.0,"10th_percentile":24462.0,"90th_percentile":24462.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19642.23,"maximum":42953.86,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35282.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23901.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31285.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22763.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36876.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22763.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":27315.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":25523.51},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22033.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22285.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30459.69},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22763.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26177.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19642.23},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31456.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23445.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":24447.46},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22990.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22763.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":36617.1},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":40149.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22763.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42953.86},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22763.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23901.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34144.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23445.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41823.72},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":22763.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22990.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22763.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21282.07,"10th_percentile":21282.07,"90th_percentile":21282.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":78514.55,"10th_percentile":78514.55,"90th_percentile":78514.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15970.74,"maximum":34925.0,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31263.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21178.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25437.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20170.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32675.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20170.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":24204.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":20752.7},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17915.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19746.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24766.22},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20170.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23195.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15970.74},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25576.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20775.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":19877.78},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20371.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20170.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":29772.7},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":32645.12},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20170.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34925.0},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20170.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21178.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30255.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20775.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34006.1},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":20170.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20371.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20170.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures With Mcc","code_information":[{"code":"319","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30308.25,"maximum":66278.43,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57475.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38934.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48273.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37080.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60071.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37080.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":44497.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":39383.16},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":33997.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36302.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46999.75},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37080.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42643.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30308.25},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48537.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38193.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":37722.79},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42683.4,"maximum":93340.55,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85802.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58123.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67984.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55356.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":89677.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55356.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":66427.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":55463.68},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":47879.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54193.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":66190.2},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55356.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63659.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42683.4},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68355.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57016.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":53125.37},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4709.94,"maximum":10299.75,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9311.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6307.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7501.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6007.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9732.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6007.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7208.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6120.19},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5283.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5881.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7303.82},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6007.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6908.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4709.94},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7542.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6187.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5862.17},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6067.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6007.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":8780.28},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9627.39},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6007.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10299.75},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6007.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6307.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9011.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6187.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10028.76},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6007.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6067.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6007.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6639.87,"maximum":14520.14,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12893.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8734.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10575.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8318.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13476.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8318.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9982.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8627.98},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7448.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8143.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10296.61},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8318.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9566.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6639.87},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10633.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8568.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8264.23},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8401.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8318.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":12378.06},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13572.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8318.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14520.14},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8318.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8734.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12477.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8568.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14138.11},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8318.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8401.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8318.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14858.46,"maximum":32492.65,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27185.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18416.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23665.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17539.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28413.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17539.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":21047.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":19307.38},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16667.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17170.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23041.38},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17539.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20170.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14858.46},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23795.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18065.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":18493.4},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4921.77,"maximum":10762.98,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9794.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6634.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7839.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6318.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10236.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6318.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7582.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6395.45},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5520.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6186.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7632.31},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6318.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7266.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4921.77},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7881.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6508.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6125.82},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6382.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6318.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":9175.18},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10060.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6318.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10762.98},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6318.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6634.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9478.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6508.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10479.8},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6318.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6382.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6318.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5914.17,"10th_percentile":5914.17,"90th_percentile":5914.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":34974.0,"10th_percentile":34974.0,"90th_percentile":34974.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6011.97,"maximum":13147.05,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11725.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7943.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9575.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7564.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12255.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7564.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9077.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7812.08},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6743.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7406.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9322.91},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7564.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8699.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6011.97},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9627.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7482.72},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7640.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7564.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11207.53},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12288.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7564.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13147.05},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7564.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7943.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11347.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12801.14},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7564.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7640.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7564.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":24053.23,"10th_percentile":24053.23,"90th_percentile":24053.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4819.65,"maximum":10539.67,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9563.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6478.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7676.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6170.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9995.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6170.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7404.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6262.75},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5406.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6040.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7473.95},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6170.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7095.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4819.65},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7718.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6355.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5998.72},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6231.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6170.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":8984.81},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9851.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6170.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10539.67},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6170.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6478.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9255.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6355.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10262.36},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6170.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6231.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6170.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3860.55,"maximum":8442.3,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7833.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5306.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6148.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5054.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8187.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5054.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":6064.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":5016.48},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":4330.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4947.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5986.65},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5054.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5812.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.55},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6182.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5205.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":4804.99},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5101.17,"maximum":11155.3,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9994.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8124.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6447.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10445.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6447.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7737.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6628.56},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5722.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6312.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7910.51},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6447.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7415.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5101.17},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8169.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6641.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6349.11},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8321.4,"maximum":18197.33,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15960.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10811.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13253.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10296.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16680.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10296.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":12356.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":10813.0},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9334.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10080.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12904.2},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10296.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11841.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8321.4},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13326.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10605.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10357.13},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10399.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10296.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":15512.78},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17009.42},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10296.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18197.33},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10296.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10811.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15445.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10605.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17718.55},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":10296.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10399.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10296.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":30386.05,"10th_percentile":30386.05,"90th_percentile":30386.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7036.62,"maximum":15387.76,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13552.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9180.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11207.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8743.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14164.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8743.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10492.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9143.53},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7893.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8559.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10911.86},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8743.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10054.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7036.62},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11268.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9005.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8758.04},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8830.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8743.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":13117.69},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14383.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8743.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15387.76},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8743.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9180.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13115.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9005.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14982.9},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8743.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8743.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","code_information":[{"code":"700","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4789.29,"maximum":10473.27,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9410.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6375.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7628.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6071.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9835.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6071.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7285.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6223.3},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5372.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5944.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7426.87},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6071.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6982.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4789.29},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7669.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6253.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5960.93},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6132.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6071.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":8928.21},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9789.59},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6071.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10473.27},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6071.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6375.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9107.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6253.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10197.72},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6071.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6132.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6071.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":6988.24,"10th_percentile":6988.24,"90th_percentile":6988.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures With Cc/Mcc","code_information":[{"code":"707","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13389.45,"maximum":29280.2,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26104.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17683.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21326.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16841.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27283.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16841.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":20209.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":17398.52},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15019.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16487.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20763.35},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16841.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19367.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13389.45},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21442.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17346.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":16665.01},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17009.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16841.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":24960.65},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27368.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16841.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29280.2},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16841.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17683.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25262.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17346.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28509.83},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":16841.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17009.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16841.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures Without Cc/Mcc","code_information":[{"code":"708","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10228.56,"maximum":22367.93,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20166.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13661.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16291.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13010.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21077.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13010.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15612.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13291.2},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11473.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12737.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15861.68},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13010.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14962.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10228.56},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16380.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13400.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12730.85},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures With Cc/Mcc","code_information":[{"code":"709","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15504.3,"maximum":33904.98,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30267.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20503.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24694.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19527.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31634.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19527.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":23432.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":20146.6},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17391.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19117.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24042.9},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19527.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22456.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15504.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24829.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20113.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":19297.24},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures Without Cc/Mcc","code_information":[{"code":"710","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10358.97,"maximum":22653.12,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18472.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12513.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16499.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11917.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19306.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11917.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":14301.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13460.66},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11620.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11667.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16063.91},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11917.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13705.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10358.97},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16589.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12275.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12893.16},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures With Cc/Mcc","code_information":[{"code":"711","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13183.14,"maximum":28829.04,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27167.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18404.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20997.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17527.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28394.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17527.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":21033.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":17130.44},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14788.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17159.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20443.42},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17527.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20156.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13183.14},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21112.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18053.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":16408.23},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures Without Cc/Mcc","code_information":[{"code":"712","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7380.24,"maximum":16139.19,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14631.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9911.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11754.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9439.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15292.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9439.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11327.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9590.03},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8278.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9241.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11444.72},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9439.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10855.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7380.24},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11819.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9722.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9185.72},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy With Cc/Mcc","code_information":[{"code":"713","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9976.71,"maximum":21817.19,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19774.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13395.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15890.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12757.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20667.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12757.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15309.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":12963.94},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11191.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12489.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15471.13},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12757.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14671.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9976.71},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15977.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13140.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12417.39},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12885.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12757.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":18598.61},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20392.97},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12757.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21817.19},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12757.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13395.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19136.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13140.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21243.16},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":12757.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12885.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12757.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12053.03,"10th_percentile":12053.03,"90th_percentile":12053.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy Without Cc/Mcc","code_information":[{"code":"714","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6483.24,"maximum":14728.93,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14092.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9546.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10326.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9091.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14728.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9091.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10910.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8424.45},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7272.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8901.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10053.72},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9091.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10455.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6483.24},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10382.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9364.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8069.28},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9182.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9091.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":12086.07},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13252.12},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9091.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14177.62},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9091.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9546.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13637.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9364.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13804.6},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":9091.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9182.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9091.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","code_information":[{"code":"715","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15581.58,"maximum":34073.98,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29123.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19728.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24817.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18789.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30438.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18789.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":22547.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":20247.02},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17478.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18394.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24162.74},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18789.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21607.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15581.58},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24953.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19352.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":19393.42},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18977.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18789.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":29047.23},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31849.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18789.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34073.98},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18789.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19728.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28183.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19352.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33177.47},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":18789.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18977.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18789.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","code_information":[{"code":"718","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8499.42,"maximum":18586.63,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17732.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12012.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13537.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11440.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18532.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11440.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13728.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11044.32},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9534.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11199.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13180.26},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11440.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13156.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8499.42},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13611.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11783.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10578.7},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Mcc","code_information":[{"code":"722","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11928.72,"maximum":26085.86,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23676.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16038.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18999.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15274.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24745.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15274.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18329.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15500.42},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13380.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14954.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18498.16},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15274.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17566.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11928.72},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19103.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15733.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14846.93},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Cc","code_information":[{"code":"723","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7748.01,"maximum":16943.44,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15179.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10282.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12340.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9792.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15864.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9792.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11751.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":10067.92},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8691.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9587.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12015.03},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9792.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11261.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7748.01},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12408.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10086.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9643.47},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9890.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9792.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":14443.86},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15837.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9792.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16943.44},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9792.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10282.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14689.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10086.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16497.65},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":9792.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9890.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9792.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System Without Cc/Mcc","code_information":[{"code":"724","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5027.34,"maximum":10993.85,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8975.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6079.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8007.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5790.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9380.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5790.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":6948.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6532.63},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5639.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5668.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7796.02},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5790.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6659.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5027.34},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8051.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5964.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6257.22},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5848.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5790.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":9371.98},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10276.17},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5790.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10993.85},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5790.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6079.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8685.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5964.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10704.59},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":5790.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5848.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5790.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy With Mcc","code_information":[{"code":"725","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8715.39,"maximum":19058.92,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15529.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10519.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13881.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10019.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16230.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10019.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":12022.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11324.95},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9776.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9808.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13515.17},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10019.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11521.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8715.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13957.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10319.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10847.5},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10119.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10019.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":16247.26},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17814.76},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10019.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19058.92},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10019.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10519.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15028.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10319.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18557.47},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":10019.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10119.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10019.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy Without Mcc","code_information":[{"code":"726","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5135.67,"maximum":11230.74,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9819.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6652.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8179.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6335.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10263.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6335.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7602.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6673.39},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5760.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6202.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7964.01},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6335.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7285.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5135.67},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8224.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6525.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6392.05},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6398.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6335.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":9573.93},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10497.61},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6335.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11230.74},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6335.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6652.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9503.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6525.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10935.26},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6335.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6398.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6335.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System With Mcc","code_information":[{"code":"727","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10138.17,"maximum":22170.27,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19512.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13218.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16147.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12589.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20394.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12589.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15106.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13173.74},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11372.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12324.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15721.51},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12589.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14477.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10138.17},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16235.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12966.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12618.35},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System Without Mcc","code_information":[{"code":"728","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5637.99,"maximum":12329.22,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10956.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7421.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8979.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7068.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11450.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7068.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8482.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7326.12},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6324.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6920.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8742.97},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7068.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8128.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5637.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9028.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7280.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7017.25},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses With Cc/Mcc","code_information":[{"code":"729","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7595.52,"maximum":16609.97,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14109.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9557.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12097.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9102.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14746.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9102.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10923.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9869.77},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8520.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8911.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11778.56},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9102.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10468.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7595.52},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12163.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9375.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9453.67},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9193.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9102.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":14159.59},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15525.68},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9102.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16609.97},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9102.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9557.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13653.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9375.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16172.95},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":9102.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9193.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9102.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses Without Cc/Mcc","code_information":[{"code":"730","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4187.61,"maximum":9597.56,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9182.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6220.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6669.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5924.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9597.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5924.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7109.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":5441.47},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":4697.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5800.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6493.83},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5924.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6813.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4187.61},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6706.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6102.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5212.06},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5983.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5924.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":7806.55},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8559.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5924.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9157.51},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5924.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6220.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8886.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6102.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8916.57},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":5924.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5983.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5924.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","code_information":[{"code":"734","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14508.63,"maximum":31727.64,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27756.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18802.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23108.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17907.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29009.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17907.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":21488.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":18852.81},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16274.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17531.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22498.89},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17907.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20593.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14508.63},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23234.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18444.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":18057.99},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","code_information":[{"code":"735","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8375.22,"maximum":18564.81,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17762.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12032.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13339.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11459.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18564.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11459.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13751.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":10882.93},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9394.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11219.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12987.66},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11459.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13178.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8375.22},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13412.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11803.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10424.11},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","code_information":[{"code":"736","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27167.37,"maximum":59409.92,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46158.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31268.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43270.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29779.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48242.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29779.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":35735.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":35301.83},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30474.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29154.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42129.11},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29779.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34246.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27167.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43507.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30672.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":33813.53},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","code_information":[{"code":"737","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13788.27,"maximum":30152.35,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26872.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18203.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21961.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17337.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28085.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17337.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":20804.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":17916.76},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15466.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16972.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21381.81},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17337.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19937.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13788.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22081.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17857.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":17161.4},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"738","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10465.92,"maximum":22887.0,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19329.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13094.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16669.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12470.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20202.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12470.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":14964.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13599.63},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11740.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12208.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16229.76},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12470.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14341.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10465.92},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16760.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12844.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13026.28},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12595.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12470.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":19510.6},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21392.95},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12470.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22887.0},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12470.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13094.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18705.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12844.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22284.83},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":12470.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12595.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12470.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","code_information":[{"code":"739","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27466.83,"maximum":60064.78,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46263.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31339.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43747.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29847.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48353.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29847.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":35817.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":35690.96},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30810.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29220.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42593.49},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29847.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34324.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27466.83},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43986.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30743.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":34186.25},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30146.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29847.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":51203.74},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":56143.79},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29847.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":60064.78},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29847.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31339.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44771.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30743.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58484.44},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":29847.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30146.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29847.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","code_information":[{"code":"740","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12545.58,"maximum":27434.82,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23674.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16037.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19982.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15274.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24744.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15274.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18328.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":16301.98},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14072.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14953.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19454.74},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15274.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17565.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12545.58},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20091.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15732.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15614.7},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15426.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15274.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":23387.51},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25643.89},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15274.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27434.82},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15274.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16037.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22911.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15732.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26712.99},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":15274.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15426.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15274.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"741","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9477.15,"maximum":20724.74,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18789.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12728.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15094.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12122.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19637.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12122.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":14546.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":12314.8},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10630.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11867.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14696.45},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12122.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13940.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9477.15},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15177.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12485.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11795.62},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12243.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12122.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":17667.33},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19371.84},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12122.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20724.74},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12122.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12728.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18183.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12485.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20179.46},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":12122.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12243.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12122.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11347.33,"10th_percentile":11347.33,"90th_percentile":11347.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11571.77,"10th_percentile":11571.77,"90th_percentile":11571.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12603.54,"maximum":27561.57,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23995.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16255.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20074.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15481.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25079.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15481.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18577.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":16377.3},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14137.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15156.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19544.62},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15481.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17803.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12603.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20183.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15945.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15686.84},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15636.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15481.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":23495.56},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25762.37},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15481.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27561.57},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15481.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16255.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23221.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15945.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26836.41},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":15481.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15636.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15481.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":40991.65,"10th_percentile":40991.65,"90th_percentile":40991.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8270.34,"maximum":18085.68,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16427.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11128.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13172.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10598.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17169.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10598.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":12718.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":10746.65},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9277.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10375.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12825.02},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10598.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12188.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8270.34},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13244.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10916.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10293.58},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10704.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10598.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":15417.59},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16905.05},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10598.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18085.68},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10598.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11128.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15897.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10916.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17609.83},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":10598.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10704.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10598.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"1 through 10","median_amount":20673.78,"10th_percentile":20673.78,"90th_percentile":20673.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10119.55,"10th_percentile":10119.55,"90th_percentile":10119.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13481.91,"maximum":29482.4,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26725.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18104.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21473.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17242.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27932.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17242.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":20690.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":17518.67},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15123.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16880.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20906.73},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17242.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19828.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13481.91},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21590.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17759.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":16780.09},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","code_information":[{"code":"745","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7071.12,"maximum":15795.40,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15112.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10237.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11262.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9750.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15795.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9750.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11700.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9188.36},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7931.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9545.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10965.36},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9750.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11212.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7071.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11324.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10042.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8800.98},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures With Cc/Mcc","code_information":[{"code":"746","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11554.05,"maximum":25266.53,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22751.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15412.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18402.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14678.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23778.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14678.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":17613.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15013.57},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12960.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14369.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17917.15},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14678.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16879.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11554.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18503.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15118.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14380.61},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","code_information":[{"code":"747","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6590.19,"maximum":14411.5,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11573.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7840.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10496.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7467.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12096.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7467.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8960.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8563.43},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7392.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7310.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10219.57},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7467.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8587.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6590.19},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10553.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7691.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8202.4},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7541.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7467.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":12285.45},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13470.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7467.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14411.5},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7467.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7840.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11200.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7691.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14032.33},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7467.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7541.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7467.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Female Reproductive System Reconstructive Procedures","code_information":[{"code":"748","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9399.18,"maximum":20554.24,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18295.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12393.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14970.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11803.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19121.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11803.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":14163.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":12213.49},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10543.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11555.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14575.54},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11803.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13573.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9399.18},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15052.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12157.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11698.57},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures With Cc/Mcc","code_information":[{"code":"749","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17859.96,"maximum":39056.37,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33331.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22579.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28446.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21503.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34836.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21503.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":25804.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":23207.59},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20034.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21052.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27695.88},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21503.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24729.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17859.96},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28601.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22149.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":22229.18},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6391.47,"maximum":13976.94,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12255.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8302.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10180.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7906.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12809.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7906.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9488.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8305.21},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7169.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7740.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9911.41},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7906.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9092.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6391.47},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10235.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8143.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7955.06},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7985.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7906.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11915.0},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13064.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7906.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13976.94},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7906.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8302.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11860.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8143.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13609.2},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7906.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7985.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7906.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41333.76,"maximum":90389.15,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78692.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53307.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65834.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50769.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":82246.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50769.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":60923.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":53709.93},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":46365.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49703.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":64097.28},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50769.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58384.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41333.76},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66193.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52292.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":51445.56},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51276.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50769.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":77054.52},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":84488.6},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50769.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":90389.15},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50769.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53307.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76153.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52292.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":88010.96},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":50769.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51276.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50769.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48403.92,"10th_percentile":48403.92,"90th_percentile":48403.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":38495.78,"10th_percentile":38495.78,"90th_percentile":38495.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47910.21,"10th_percentile":47910.21,"90th_percentile":47910.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Lead Procedures","code_information":[{"code":"265","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24611.61,"maximum":53820.95,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46714.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31645.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39200.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30138.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48824.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30138.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":36166.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":31980.83},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27607.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29505.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38165.83},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30138.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34659.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24611.61},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39414.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31042.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":30632.54},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30439.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30138.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":45881.03},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":50307.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30138.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53820.95},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30138.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31645.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45207.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31042.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52404.89},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":30138.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30439.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30138.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24114.81,"maximum":52734.55,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43178.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29249.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38408.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27857.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45128.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27857.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":33428.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":31335.27},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27050.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27272.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37395.43},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27857.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32035.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24114.81},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38618.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28692.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":30014.2},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28135.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27857.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":44954.9},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":49292.07},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27857.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52734.55},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27857.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29249.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41785.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28692.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51347.07},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":27857.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28135.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27857.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12966.0,"10th_percentile":12966.0,"90th_percentile":12966.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein Ligation And Stripping","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18505.11,"maximum":41357.73,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39570.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26805.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29474.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25529.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41357.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25529.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":30635.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":24045.92},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20757.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24993.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28696.33},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25529.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29358.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18505.11},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29635.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26295.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":23032.16},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10472.13,"maximum":22900.58,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21385.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14487.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16679.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13797.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22351.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13797.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":16556.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13607.7},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11747.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13507.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16239.39},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13797.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15866.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10472.13},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16770.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14211.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13034.01},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Cc","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13092.06,"maximum":28629.87,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24705.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16735.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20852.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15938.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25821.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15938.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":19126.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":17012.09},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14685.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15604.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20302.18},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15938.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18329.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13092.06},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20966.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16417.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":16294.87},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Mcc","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23506.92,"maximum":51405.21,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42059.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28492.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37440.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27135.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43959.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27135.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":32562.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":30545.37},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26368.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26565.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36452.76},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27135.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31205.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23506.92},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37645.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27949.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":29257.6},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement Without Mcc","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12127.44,"maximum":27573.32,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26381.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17871.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19316.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17020.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27573.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17020.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":20424.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15758.64},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13603.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16663.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18806.32},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17020.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19573.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12127.44},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19421.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17531.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15094.27},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17190.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17020.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":22608.01},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24789.19},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17020.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26520.43},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17020.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17871.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25530.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17531.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25822.66},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":17020.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17190.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17020.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement With Mcc","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19357.26,"maximum":42485.46,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40649.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27536.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30831.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26225.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42485.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26225.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":31470.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":25153.22},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21713.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25674.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30017.78},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26225.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30159.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19357.26},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30999.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27012.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":24092.78},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","code_information":[{"code":"257","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6154.11,"maximum":15192.26,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14535.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9846.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9801.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9377.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15192.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9377.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11253.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7996.78},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6903.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9181.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9543.33},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9377.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10784.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6154.11},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9855.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9659.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7659.64},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11685.84,"maximum":25554.73,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22251.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15073.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18612.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14356.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23256.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14356.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":17227.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15184.82},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13108.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14054.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18121.52},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14356.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16509.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11685.84},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18714.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14786.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14544.64},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18052.47,"maximum":39477.35,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34984.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23699.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28753.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22570.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36564.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22570.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":27084.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":23457.75},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20250.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22096.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27994.41},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22570.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25956.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18052.47},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28910.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23247.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":22468.78},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12070.17,"maximum":26395.19,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23319.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15797.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19224.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15044.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24372.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15044.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18053.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15684.22},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13539.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14728.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18717.51},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15044.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17301.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12070.17},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19329.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15496.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15022.99},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17615.01,"maximum":38520.71,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33687.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22820.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28056.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21734.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35209.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21734.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":26080.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":22889.3},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19759.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21277.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27316.03},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21734.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24994.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17615.01},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28209.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22386.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":21924.31},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21951.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21734.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":32837.95},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":36006.1},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21734.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38520.71},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21734.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22820.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32601.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22386.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37507.21},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":21734.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21951.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21734.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20296.83,"10th_percentile":20296.83,"90th_percentile":20296.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20557.94,"10th_percentile":20557.94,"90th_percentile":20557.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23668.38,"maximum":51758.29,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45059.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30524.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37697.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29070.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47094.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29070.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":34885.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":30755.17},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26549.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28460.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36703.14},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29070.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33431.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23668.38},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37903.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29943.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":29458.56},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29361.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29070.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":44122.66},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":48379.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29070.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51758.29},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29070.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30524.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43606.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29943.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50396.5},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":29070.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29361.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29070.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10781.25,"maximum":23576.56,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19660.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13318.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17171.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12684.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20548.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12684.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15221.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14009.38},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12093.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12417.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16718.75},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12684.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14587.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10781.25},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17265.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13064.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13418.75},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15957.63,"maximum":34896.33,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28425.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19255.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25416.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18338.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29708.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18338.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":22006.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":20735.67},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17900.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17953.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24745.89},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18338.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21089.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15957.63},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25555.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18889.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":19861.47},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18522.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18338.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":29748.26},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":32618.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18338.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34896.33},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18338.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19255.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27508.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18889.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33978.19},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":18338.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18522.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18338.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Generator Procedures","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33716.85,"maximum":73732.4,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58742.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39793.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53702.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37898.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61395.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37898.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":45478.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":43812.36},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":37821.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37102.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52285.55},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37898.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43583.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33716.85},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53995.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39035.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":41965.26},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12452.43,"maximum":27231.12,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23648.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16019.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19833.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15256.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24716.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15256.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18308.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":16180.94},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13968.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14936.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19310.29},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15256.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17545.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12452.43},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19941.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15714.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15498.76},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15543.63,"maximum":33990.99,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27767.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18810.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24757.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17914.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29021.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17914.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":21497.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":20197.71},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17435.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17538.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24103.89},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17914.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20601.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15543.63},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24892.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18452.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":19346.19},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18093.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17914.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":28976.48},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31772.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17914.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33990.99},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17914.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18810.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26872.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18452.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33096.67},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":17914.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18093.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17914.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16751.95,"10th_percentile":16751.95,"90th_percentile":16751.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17092.32,"10th_percentile":17092.32,"90th_percentile":17092.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Mcc","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23404.8,"maximum":51181.89,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41295.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27974.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37278.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26642.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43160.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26642.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":31970.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":30412.67},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26254.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26082.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36294.4},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26642.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30638.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23404.8},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37481.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27441.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":29130.5},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26908.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26642.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":43631.3},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":47840.77},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26642.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51181.89},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26642.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27974.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39963.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27441.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49835.26},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":26642.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26908.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26642.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7597.64,"10th_percentile":7597.64,"90th_percentile":7597.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33626.69,"10th_percentile":33626.69,"90th_percentile":33626.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10417.62,"maximum":22781.37,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18258.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12368.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16592.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11779.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19082.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11779.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":14135.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13536.87},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11685.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11532.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16154.86},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11779.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13546.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10417.62},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16683.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12132.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12966.16},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11897.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11779.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":19420.56},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21294.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11779.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22781.37},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11779.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12368.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17669.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12132.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22181.98},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":11779.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11897.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11779.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20092.8,"maximum":43939.17,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36934.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25020.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32002.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23829.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38602.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23829.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":28594.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":26108.99},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22538.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23328.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31158.4},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23829.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27403.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20092.8},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32177.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24543.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":25008.26},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24067.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23829.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":37457.06},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":41070.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23829.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43939.17},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23829.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25020.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35743.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24543.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42783.1},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":23829.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24067.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23829.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15381.47,"10th_percentile":15381.47,"90th_percentile":15381.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34751.85,"maximum":75995.75,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63320.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42894.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55351.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40851.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66179.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40851.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":49022.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":45157.26},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":38982.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39993.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53890.55},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40851.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46979.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34751.85},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55653.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42077.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":43253.46},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization Without Mcc","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28371.42,"maximum":62042.95,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53983.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36569.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45188.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34828.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56421.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34828.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":41793.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":36866.4},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31825.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34096.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43996.26},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34828.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40052.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28371.42},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45435.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35873.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":35312.14},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35176.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34828.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":52890.08},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":57992.83},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34828.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":62042.95},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34828.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36569.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52242.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35873.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":60410.57},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":34828.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35176.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34828.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization With Mcc","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40598.22,"maximum":88780.66,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75382.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51065.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64662.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48634.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78787.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48634.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":58360.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":52754.15},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":45540.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47612.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":62956.66},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48634.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55929.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40598.22},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65015.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50093.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":50530.07},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49120.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48634.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":75683.32},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":82985.12},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48634.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":88780.66},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48634.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51065.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":72951.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50093.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":86444.79},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":48634.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49120.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48634.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46368.95,"10th_percentile":46368.95,"90th_percentile":46368.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":78371.39,"10th_percentile":78371.39,"90th_percentile":78371.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36707.31,"maximum":80271.97,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70211.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47562.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58465.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45298.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":73382.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45298.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":54357.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":47698.22},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":41176.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44346.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":56922.93},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45298.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52092.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36707.31},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58784.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46656.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":45687.3},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45751.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45298.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":68429.87},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":75031.87},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45298.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":80271.97},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45298.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47562.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":67947.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46656.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":78159.97},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":45298.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45751.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45298.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":53929.02,"maximum":117932.61,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98015.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66397.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85895.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63235.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":102441.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63235.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":75882.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":70076.46},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":60494.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61907.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":83629.06},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63235.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":72720.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53929.02},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86364.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65132.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":67122.09},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63867.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63235.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":100534.64},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":110234.04},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63235.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":117932.61},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63235.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66397.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":94853.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65132.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":114829.73},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":63235.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63867.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63235.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":30317.96,"10th_percentile":30317.96,"90th_percentile":30317.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca Without Mcc","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42147.27,"maximum":92168.14,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77854.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52739.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67130.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50228.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":81370.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50228.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":60274.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":54767.02},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":47278.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49173.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":65358.81},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50228.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57762.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42147.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67496.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51735.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":52458.08},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50730.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50228.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":78571.06},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":86151.46},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50228.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":92168.14},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50228.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52739.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75342.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51735.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":89743.14},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":50228.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50730.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50228.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca With Mcc","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":58466.46,"maximum":127855.13,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108011.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73169.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93122.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69684.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":112889.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69684.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":83621.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":75972.5},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":65584.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68221.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":90665.38},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69684.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":80137.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58466.46},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93631.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71775.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":72769.56},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70381.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69684.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":108993.34},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":119508.83},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69684.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":127855.13},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69684.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73169.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":104527.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71775.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":124491.19},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":69684.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70381.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69684.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21432.09,"maximum":46867.94,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40743.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27600.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34136.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26286.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42583.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26286.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":31543.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":27849.29},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24041.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25734.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33235.27},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26286.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30229.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21432.09},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34322.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27075.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":26675.19},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26549.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26286.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":39953.76},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":43808.43},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26286.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46867.94},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26286.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27600.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39429.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27075.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45634.82},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":26286.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26549.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26286.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34382.01,"maximum":75186.98,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63647.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43116.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54762.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41062.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66521.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41062.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":49275.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":44676.68},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":38567.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40200.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53317.03},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41062.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47222.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34382.01},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55061.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42294.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":42793.15},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31686.87,"maximum":69293.21,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64829.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43916.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50469.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41825.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":67757.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41825.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":50190.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":41174.56},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":35544.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40947.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49137.61},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41825.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48099.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31686.87},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50744.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43080.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":39438.67},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42243.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41825.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":59070.75},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":64769.8},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41825.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":69293.21},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41825.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43916.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62738.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43080.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":67470.07},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":41825.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42243.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41825.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","code_information":[{"code":"220","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36544.47,"maximum":79915.87,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68557.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46441.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58206.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44230.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":71653.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44230.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":53076.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":47486.63},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":40993.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43301.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":56670.41},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44230.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50864.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36544.47},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58524.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45557.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":45484.62},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":53385.3,"maximum":116743.59,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98436.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66682.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85029.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63507.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":102882.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63507.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":76209.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":69369.94},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":59884.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62173.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":82785.9},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63507.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73033.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53385.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85493.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65412.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":66445.36},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","code_information":[{"code":"218","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41048.79,"maximum":89765.97,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84385.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57164.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65380.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54442.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":88196.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54442.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":65330.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":53339.63},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":46046.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53298.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":63655.37},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54442.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62608.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41048.79},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65737.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56075.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":51090.87},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","code_information":[{"code":"217","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44556.06,"maximum":97435.71,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84385.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57164.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70966.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54442.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":88196.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54442.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":65330.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":57897.05},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":49980.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53298.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":69094.18},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54442.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62608.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44556.06},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71354.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56075.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":55456.15},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"476","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8024.7,"maximum":17548.51,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15656.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10606.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12781.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10101.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16363.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10101.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":12121.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":10427.46},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9001.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9889.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12444.1},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10101.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11616.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8024.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12851.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10404.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9987.84},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23727.72,"maximum":51888.05,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44630.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30233.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37792.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28793.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46646.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28793.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":34552.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":30832.28},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26616.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28189.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36795.16},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28793.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33113.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23727.72},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37998.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29657.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":29532.41},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"478","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16134.96,"maximum":35284.12,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31950.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21643.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25699.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20612.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33393.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20612.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":24735.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":20966.09},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18099.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20180.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25020.88},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20612.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23704.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16134.96},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25839.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21231.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":20082.18},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20819.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20612.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":30078.84},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":32980.79},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20612.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35284.12},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20612.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21643.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30919.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21231.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34355.77},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":20612.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20819.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20612.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19270.55,"10th_percentile":19270.55,"90th_percentile":19270.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"479","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12252.33,"maximum":26793.54,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24302.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16463.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19514.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15679.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25400.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15679.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18815.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15920.93},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13743.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15350.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18999.99},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15679.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18031.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12252.33},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19621.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16149.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15249.71},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15836.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15679.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":22840.83},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25044.47},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15679.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26793.54},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15679.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16463.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23518.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16149.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26088.58},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":15679.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15836.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15679.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Mcc","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20292.9,"maximum":44376.75,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37722.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25553.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32321.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24336.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39425.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24336.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":29204.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":26369.01},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22763.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23825.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31468.7},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24336.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27987.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20292.9},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32498.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25067.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":25257.31},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14316.81,"maximum":31308.17,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27304.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18496.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22803.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17615.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28537.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17615.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":21138.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":18603.55},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16059.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17245.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22201.43},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17615.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20257.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14316.81},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22927.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18144.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":17819.24},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10946.16,"maximum":23937.19,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21399.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14496.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17434.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13806.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22366.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13806.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":16567.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14223.66},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12278.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13516.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16974.48},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13806.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15877.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10946.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17529.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14220.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13624.0},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17581.89,"maximum":38448.28,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35933.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24342.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28003.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23183.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37556.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23183.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":27819.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":22846.26},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19722.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22696.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27264.67},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23183.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26660.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17581.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28156.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23878.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":21883.08},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23414.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23183.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":32776.21},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":35938.4},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23183.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38448.28},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23183.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24342.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34774.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23878.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37436.69},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":23183.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23414.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23183.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Mcc","code_information":[{"code":"485","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22242.84,"maximum":48640.9,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41732.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28270.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35427.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26924.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43617.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26924.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":32309.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":28902.8},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24950.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26358.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34492.52},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26924.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30962.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22242.84},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35620.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27731.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":27684.28},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27193.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26924.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":41465.17},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":45465.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26924.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48640.9},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26924.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28270.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40386.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27731.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47361.13},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":26924.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27193.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26924.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Cc","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14632.83,"maximum":31999.24,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27260.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18467.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23306.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17587.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28492.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17587.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":21105.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":19014.2},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16414.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17218.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22691.49},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17587.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20225.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14632.83},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23433.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18115.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":18212.57},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10902.69,"maximum":23842.13,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20574.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13937.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17365.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13273.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21503.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13273.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15928.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14167.18},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12229.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12994.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16907.07},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13273.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15264.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10902.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17460.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13671.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13569.9},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13406.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13273.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":20324.83},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22285.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13273.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23842.13},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13273.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13937.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19910.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13671.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23214.83},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":13273.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13406.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13273.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13560.57,"maximum":29654.41,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23156.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15686.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21598.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14939.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24202.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14939.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":17927.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":17620.88},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15211.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14625.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21028.71},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14939.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17180.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13560.57},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21716.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15387.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":16878.0},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15088.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14939.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":25279.65},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27718.59},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14939.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29654.41},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14939.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15686.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22409.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15387.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28874.19},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":14939.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15088.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14939.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8546.34,"maximum":18689.24,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14849.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10059.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13612.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9580.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15519.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9580.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11496.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11105.29},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9586.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9378.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13253.02},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9580.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11017.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8546.34},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13686.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9867.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10637.1},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24501.9,"maximum":53581.04,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47395.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32106.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39025.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30577.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49535.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30577.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":36692.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":31838.27},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27484.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29935.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37995.7},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30577.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35164.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24501.9},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39238.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31494.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":30495.99},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30883.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30577.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":45676.51},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":50083.3},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30577.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53581.04},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30577.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32106.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45866.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31494.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52171.29},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":30577.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30883.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30577.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16566.9,"maximum":36228.69,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32929.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22307.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26386.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21245.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34416.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21245.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":25494.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":21527.37},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18583.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20798.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25690.7},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21245.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24431.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16566.9},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26531.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21882.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":20619.79},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13009.95,"maximum":28450.31,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26183.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17736.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20721.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16892.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27365.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16892.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":20270.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":16905.39},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14593.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16537.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20174.85},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16892.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19426.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13009.95},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20834.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17399.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":16192.67},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24290.07,"maximum":53117.81,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46810.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31710.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38688.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30200.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48924.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30200.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":36240.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":31563.01},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27247.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29565.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37667.21},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30200.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34730.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24290.07},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38899.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31106.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":30232.34},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","code_information":[{"code":"496","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13613.01,"maximum":29769.09,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23602.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15988.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21682.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15227.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24668.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15227.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18272.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":17689.02},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15270.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14907.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21110.03},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15227.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17511.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13613.01},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21800.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15684.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":16943.27},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","code_information":[{"code":"497","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9266.7,"maximum":20264.53,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16014.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10848.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14759.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10332.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16738.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10332.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":12398.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":12041.34},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10394.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10115.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14370.1},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10332.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11881.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9266.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14840.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10642.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11533.68},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","code_information":[{"code":"498","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17420.43,"maximum":40817.16,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39053.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26455.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27746.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25195.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40817.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25195.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":30234.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":22636.46},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19541.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24666.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27014.29},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25195.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28975.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17420.43},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27897.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25951.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":21682.12},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":66587.76,"maximum":145614.89,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":125246.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84844.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":106057.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80803.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":130902.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80803.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":96964.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":86525.49},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":74694.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79107.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":103259.28},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80803.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":92924.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66587.76},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":106636.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83228.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":82877.64},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":75547.02,"10th_percentile":75547.02,"90th_percentile":75547.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Heart Assist System Implant","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":73099.98,"maximum":159855.88,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":127465.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86347.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116430.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82235.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":133221.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82235.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":98682.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":94987.6},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":81999.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80508.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":113357.94},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82235.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":94570.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":73099.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":117065.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84702.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":90982.99},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Aortic And Mitral Valve Procedures","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":75162.39,"maximum":164365.99,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":139148.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94261.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":119715.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89773.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145432.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89773.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":107727.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":97667.53},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":84312.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87887.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":116556.17},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89773.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":103239.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75162.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":120368.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92466.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":93549.94},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18520.29,"maximum":40500.38,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35638.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24141.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29498.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22992.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37247.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22992.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":27590.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":24065.64},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20774.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22509.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28719.87},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22992.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26441.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18520.29},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29659.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23682.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":23051.05},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44627.13,"maximum":97591.13,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82594.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55951.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71080.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53286.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":86324.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53286.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":63944.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":57989.4},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":50060.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52167.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":69204.39},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53286.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61279.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44627.13},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71468.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54885.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":55544.61},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53819.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53286.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":83194.03},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":91220.44},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53286.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":97591.13},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53286.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55951.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":79930.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54885.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":95023.45},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":53286.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53819.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53286.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6250.02,"maximum":13667.62,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12610.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8542.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9954.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8136.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13180.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8136.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9763.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8121.4},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7010.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7965.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9692.06},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8136.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9356.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6250.02},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10009.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8380.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7779.01},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8217.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8136.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11651.31},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12775.4},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8136.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13667.62},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8136.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8542.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12204.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8380.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13308.01},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8136.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8217.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8136.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7733.08,"10th_percentile":7733.08,"90th_percentile":7733.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13025.13,"maximum":28483.51,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23947.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16222.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20745.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15449.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25028.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15449.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18539.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":16925.12},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14610.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15125.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20198.39},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15449.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17767.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13025.13},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20859.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15913.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":16211.57},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15604.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15449.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":24281.49},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26624.12},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15449.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28483.51},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15449.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16222.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23174.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15913.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27734.09},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":15449.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15604.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15449.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5595.21,"maximum":12235.67,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10907.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7389.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8911.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7037.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11400.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7037.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8444.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7270.53},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6276.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6889.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8676.63},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7037.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8092.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5595.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8960.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7248.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6964.01},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7107.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7037.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":10430.61},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11436.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7037.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12235.67},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7037.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7389.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10555.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7248.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11913.74},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7037.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7107.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7037.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4804.47,"maximum":10506.47,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9157.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6203.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7652.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5907.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9570.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5907.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7089.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6243.03},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5389.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5783.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7450.41},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5907.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6794.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4804.47},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7694.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6085.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5979.82},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2606.08,"10th_percentile":2606.08,"90th_percentile":2606.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2530.17,"10th_percentile":2530.17,"90th_percentile":2530.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":19310.02,"10th_percentile":19310.02,"90th_percentile":19310.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3242.76,"10th_percentile":3242.76,"90th_percentile":3242.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6670.23,"maximum":14586.54,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12994.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8802.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10624.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8383.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13581.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8383.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10060.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8667.43},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7482.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8207.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10343.69},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8383.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9640.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6670.23},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10682.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8634.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8302.02},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"1 through 10","median_amount":11164.21,"10th_percentile":11164.21,"90th_percentile":11164.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4577.25,"10th_percentile":4577.25,"90th_percentile":4577.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4670.61,"maximum":10213.74,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9731.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6592.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7439.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10171.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7534.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6069.09},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5239.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6146.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7242.83},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7220.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4670.61},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7479.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6467.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5813.22},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6341.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":8706.96},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9547.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10213.74},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6592.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9417.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6467.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9945.01},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6278.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6341.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7641.06,"maximum":16709.56,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14626.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9908.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12170.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9436.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15286.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9436.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11323.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9928.95},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8571.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9238.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11849.18},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9436.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10851.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7641.06},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12236.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9719.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9510.35},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9530.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9436.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":14244.49},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15618.77},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9436.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16709.56},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9436.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9908.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14154.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9719.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16269.92},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":9436.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9530.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9436.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12179.88,"maximum":26635.1,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23095.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15645.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19399.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14900.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24138.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14900.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":17880.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15826.78},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13662.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14587.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18887.64},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14900.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17135.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12179.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19505.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15347.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15159.54},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4832.76,"maximum":10568.34,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9745.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6602.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7697.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6287.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10186.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6287.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7545.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6279.79},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5421.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6155.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7494.28},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6287.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7230.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4832.76},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7739.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6476.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6015.04},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6830.31,"maximum":14936.6,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12712.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8611.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10879.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13286.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9842.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8875.44},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7661.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8029.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10591.93},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9432.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6830.31},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10938.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8447.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8501.26},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8283.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":12733.08},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13961.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14936.6},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8611.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12302.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8447.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14543.61},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8201.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8283.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13000.98,"maximum":28430.69,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24663.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16707.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20707.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15911.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25777.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15911.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":19094.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":16893.74},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14583.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15577.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20160.94},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15911.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18298.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13000.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20820.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16389.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":16181.51},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16070.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15911.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":24236.46},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26574.76},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15911.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28430.69},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15911.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16707.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23867.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16389.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27682.67},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":15911.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16070.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15911.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4297.32,"maximum":9397.43,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8628.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5845.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6844.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5566.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9018.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5566.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":6680.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":5584.02},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":4820.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5450.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6663.96},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5566.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6401.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4297.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6881.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5733.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5348.61},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5622.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5566.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":8011.08},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8783.97},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5566.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9397.43},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5566.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5845.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8350.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5733.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9150.18},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":5566.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5622.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5566.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2818.98,"10th_percentile":2818.98,"90th_percentile":2818.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5658.0,"maximum":12372.98,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10888.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7376.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9011.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11380.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8429.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7352.12},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6346.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6877.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8774.0},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8078.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5658.0},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9061.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7235.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7042.16},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7095.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":10547.66},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11565.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12372.98},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7376.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10537.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7235.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12047.44},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7024.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7095.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6579.59,"10th_percentile":6579.59,"90th_percentile":6579.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9092.82,"maximum":19884.28,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17366.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11764.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14482.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11204.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18150.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11204.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13444.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11815.39},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10199.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10968.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14100.46},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11204.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12884.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9092.82},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14561.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11540.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11317.27},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11316.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11204.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":16950.86},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18586.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11204.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19884.28},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11204.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11764.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16806.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11540.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19361.12},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":11204.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11316.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11204.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5790.79,"10th_percentile":5790.79,"90th_percentile":5790.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10696.82,"10th_percentile":10696.82,"90th_percentile":10696.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10587.72,"10th_percentile":10587.72,"90th_percentile":10587.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4465.68,"maximum":9765.6,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8800.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5961.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7112.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5677.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9198.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5677.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":6813.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":5802.8},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5009.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5558.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6925.04},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5677.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6529.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4465.68},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7151.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5848.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5558.15},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5734.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5677.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":8324.93},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9128.11},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5677.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9765.6},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5677.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5961.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8516.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5848.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9508.66},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":5677.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5734.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5677.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5927.79,"maximum":12962.96,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11361.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7696.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9441.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11874.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8795.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7702.69},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6649.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9192.37},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8429.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.79},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9493.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7549.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7377.95},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7403.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11050.6},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12116.75},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12962.96},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7696.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10994.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7549.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12621.9},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7329.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7403.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":350.0,"10th_percentile":350.0,"90th_percentile":350.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7750.77,"maximum":16949.47,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14733.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9980.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12345.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9505.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15398.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9505.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11406.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":10071.51},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8694.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9305.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12019.31},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9505.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10931.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7750.77},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12412.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9790.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9646.9},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9600.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9505.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":14449.01},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15843.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9505.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16949.47},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9505.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9980.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14258.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9790.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16503.52},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":9505.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9600.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9505.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5553.97,"10th_percentile":5553.97,"90th_percentile":5553.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5343.87,"10th_percentile":5343.87,"90th_percentile":5343.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8538.75,"maximum":18672.64,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16360.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11082.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13600.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10554.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17098.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10554.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":12665.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11095.43},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9578.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10333.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13241.25},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10554.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12138.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8538.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13674.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10871.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10627.65},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10660.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10554.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":15917.96},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17453.7},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10554.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18672.64},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10554.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11082.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15832.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10871.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18181.35},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":10554.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10660.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10554.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3954.46,"10th_percentile":3954.46,"90th_percentile":7299.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8589.11,"10th_percentile":8589.11,"90th_percentile":8589.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5065.29,"maximum":11076.83,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9758.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6610.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8067.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6295.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10199.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6295.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7555.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6581.94},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5681.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6163.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7854.87},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6295.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7240.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5065.29},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8111.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6484.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6304.45},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6358.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6295.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":9442.73},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10353.75},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6295.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11076.83},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6295.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6610.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9443.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6484.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10785.4},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6295.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6358.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6295.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6926.91,"maximum":15147.85,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13222.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8957.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11032.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8530.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13819.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8530.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10236.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9000.97},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7770.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8351.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10741.73},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8530.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9810.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6926.91},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11093.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8786.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8621.49},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8615.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8530.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":12913.17},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14159.01},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8530.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15147.85},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8530.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8957.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12795.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8786.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14749.3},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8530.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8615.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8530.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10902.0,"maximum":23840.62,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20476.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13870.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17364.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13210.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21400.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13210.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15852.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14166.28},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12229.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12932.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16906.0},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13210.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15191.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10902.0},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17459.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13606.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13569.04},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13342.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13210.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":20323.54},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22284.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13210.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23840.62},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13210.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13870.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19815.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13606.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23213.36},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":13210.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13342.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13210.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8102.92,"10th_percentile":8102.92,"90th_percentile":8102.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5365.44,"maximum":11733.21,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10641.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7208.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8545.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6865.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11122.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6865.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8238.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6971.96},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6018.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6721.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8320.32},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6865.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7895.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5365.44},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8592.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7071.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6678.03},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6934.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6865.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":10002.27},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10967.27},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6865.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11733.21},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6865.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7208.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10298.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7071.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11424.5},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6865.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6934.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6865.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7369.2,"maximum":16115.05,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14177.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9604.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11737.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9147.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14818.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9147.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10976.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9575.69},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8266.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8954.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11427.6},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9147.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10519.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7369.2},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11801.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9421.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9171.98},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9238.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9147.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":13737.68},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15063.07},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9147.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16115.05},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9147.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9604.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13720.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9421.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15691.06},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":9147.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9238.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9147.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8608.95,"10th_percentile":8608.95,"90th_percentile":8608.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10951.68,"maximum":23949.26,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20111.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13624.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17443.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12975.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21019.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12975.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15570.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14230.84},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12284.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12702.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16983.04},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12975.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14921.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10951.68},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17538.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13364.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13630.87},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13105.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12975.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":20416.15},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22385.87},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12975.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23949.26},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12975.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13624.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19462.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13364.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23319.14},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":12975.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13105.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12975.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"1 through 10","median_amount":14880.0,"10th_percentile":14880.0,"90th_percentile":14880.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Respiratory Neoplasms Without Cc/Mcc","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5778.75,"maximum":12637.04,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10224.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6926.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9204.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6596.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10686.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6596.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7916.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7509.03},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6482.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6458.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8961.25},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6596.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7586.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5778.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9254.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6794.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7192.45},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6662.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6596.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":10772.76},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11812.1},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6596.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12637.04},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6596.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6926.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9895.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6794.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12304.55},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6596.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6662.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6596.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7660.38,"maximum":16751.81,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14265.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9663.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12201.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9203.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14910.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9203.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11044.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9954.05},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8592.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9010.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11879.14},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9203.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10584.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7660.38},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12267.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9479.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9534.4},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9295.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9203.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":14280.5},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15658.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9203.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16751.81},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9203.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9663.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13805.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9479.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16311.06},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":9203.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9295.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9203.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12059.13,"maximum":26371.05,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23119.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15661.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19207.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14915.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24163.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14915.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":17898.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15669.88},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13527.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14602.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18700.39},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14915.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17153.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12059.13},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19312.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15363.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15009.25},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15064.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14915.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":22480.67},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24649.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14915.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26371.05},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14915.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15661.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22373.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15363.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25677.21},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":14915.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15064.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14915.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14103.94,"10th_percentile":14103.94,"90th_percentile":14103.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5310.93,"maximum":11614.0,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10240.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6936.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8459.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6606.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10702.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6606.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7927.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6901.13},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5957.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6467.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8235.79},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6606.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7597.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5310.93},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8505.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6804.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6610.18},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6672.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6606.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":9900.65},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10855.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6606.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11614.0},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6606.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6936.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9909.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6804.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11308.43},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6606.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6672.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6606.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6845.49,"maximum":14969.8,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13055.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8844.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10903.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8422.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13645.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8422.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10107.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8895.17},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7678.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8246.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10615.47},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8422.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9686.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6845.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10962.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8675.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8520.15},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8507.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8422.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":12761.38},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13992.58},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8422.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14969.8},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8422.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8844.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12634.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8675.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14575.93},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8422.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8507.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8422.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8001.35,"10th_percentile":8001.35,"90th_percentile":8001.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11153.85,"maximum":24391.37,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20529.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13907.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17765.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13244.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21456.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13244.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15893.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14493.54},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12511.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12966.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17296.55},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13244.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15231.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11153.85},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17862.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13642.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13882.5},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13377.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13244.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":20793.04},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22799.12},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13244.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24391.37},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13244.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13907.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19867.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13642.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23749.62},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":13244.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13377.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13244.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12404.49,"10th_percentile":12404.49,"90th_percentile":12404.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5620.05,"maximum":12289.99,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10877.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7368.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8951.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11368.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8421.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7302.81},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6304.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6870.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8715.15},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8070.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5620.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9000.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7228.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6994.93},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7087.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":10476.91},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11487.71},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12289.99},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7368.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10526.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7228.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11966.63},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7017.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7087.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"1 through 10","median_amount":8846.95,"10th_percentile":8846.95,"90th_percentile":8846.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":20616.83,"10th_percentile":20616.83,"90th_percentile":20616.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9722.79,"maximum":21261.91,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18120.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12275.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15486.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11690.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18938.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11690.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":14028.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":12633.99},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10906.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11445.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15077.37},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11690.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13444.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9722.79},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15570.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12041.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12101.35},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11807.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11690.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":18125.25},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19873.95},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11690.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21261.91},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11690.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12275.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17536.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12041.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20702.5},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":11690.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11807.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11690.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10937.32,"10th_percentile":10937.32,"90th_percentile":10937.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21171.96,"maximum":46299.09,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38538.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26106.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33721.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24863.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40279.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24863.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":29836.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":27511.27},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23749.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24341.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32831.88},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24863.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28593.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21171.96},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33905.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25609.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":26351.42},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25112.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24863.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":39468.83},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":43276.71},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24863.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46299.09},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24863.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26106.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37295.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25609.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45080.93},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":24863.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25112.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24863.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9341.22,"maximum":20427.49,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18028.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12213.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14878.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11631.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18843.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11631.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13957.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":12138.17},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10478.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11387.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14485.66},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11631.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13376.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9341.22},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14959.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11980.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11626.43},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11747.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11631.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":17413.93},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19094.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11631.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20427.49},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11631.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12213.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17447.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11980.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19890.03},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":11631.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11747.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11631.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"1 through 10","median_amount":10298.0,"10th_percentile":10298.0,"90th_percentile":10298.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","code_information":[{"code":"499","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8009.52,"maximum":27476.14,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26288.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17808.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12757.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16960.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27476.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16960.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":20352.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":10407.73},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8984.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16604.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12420.56},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16960.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19504.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8009.52},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12826.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17469.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9968.95},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17130.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16960.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":14931.37},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16371.92},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16960.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17515.31},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16960.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17808.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25440.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17469.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17054.47},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":16960.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17130.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16960.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Mcc","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21862.65,"maximum":47809.5,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40938.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27732.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34821.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26412.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42787.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26412.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":31694.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":28408.77},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24524.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25857.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33902.95},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26412.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30373.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21862.65},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35011.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27204.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":27211.08},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26676.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26412.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":40756.42},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":44688.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26412.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47809.5},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26412.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27732.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39618.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27204.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46551.6},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":26412.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26676.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26412.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12315.81,"maximum":26932.36,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22891.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15507.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19616.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14768.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23925.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14768.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":17722.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":16003.41},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13815.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14458.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19098.43},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14768.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16983.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12315.81},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19723.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15211.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15328.72},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14916.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14768.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":22959.17},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25174.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14768.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26932.36},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14768.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15507.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22152.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15211.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26223.75},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":14768.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14916.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14768.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures Without Cc/Mcc","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9639.99,"maximum":21080.84,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17767.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12036.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15354.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11463.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18570.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11463.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13755.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":12526.4},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10813.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11222.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14948.97},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11463.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13182.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9639.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15437.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11806.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11998.29},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Mcc","code_information":[{"code":"503","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18260.85,"maximum":39933.04,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36178.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24507.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29085.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23340.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37812.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23340.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":28008.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":23728.52},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20483.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22850.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28317.55},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23340.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26841.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18260.85},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29243.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24041.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":22728.14},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23574.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23340.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":34041.93},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":37326.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23340.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39933.04},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23340.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24507.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35011.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24041.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38882.38},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":23340.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23574.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23340.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Cc","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12113.64,"maximum":26490.25,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24434.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16552.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19294.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15763.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25537.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15763.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18916.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15740.71},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13588.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15432.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18784.92},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15763.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18128.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12113.64},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19399.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16236.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15077.09},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15921.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15763.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":22582.28},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24760.98},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15763.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26490.25},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15763.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16552.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23645.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16236.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25793.28},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":15763.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15921.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15763.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12113.64,"maximum":26490.25,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23460.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15892.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19294.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15136.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24520.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15136.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18163.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15740.71},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13588.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14818.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18784.92},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15136.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17406.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12113.64},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19399.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15590.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15077.09},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15287.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15136.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":22582.28},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24760.98},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15136.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26490.25},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15136.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15892.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22704.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15590.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25793.28},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":15136.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15287.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15136.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Thumb Or Joint Procedures","code_information":[{"code":"506","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10343.1,"maximum":22618.41,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17809.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12064.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16474.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11490.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18614.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11490.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13788.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13440.03},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11602.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11248.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16039.3},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11490.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13213.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10343.1},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16563.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11834.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12873.41},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11605.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11490.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":19281.64},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21141.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11490.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22618.41},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11490.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12064.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17235.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11834.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22023.31},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":11490.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11605.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11490.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13372.89,"maximum":29243.99,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23634.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16010.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21299.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15247.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24701.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15247.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18297.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":17377.0},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15000.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14927.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20737.67},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15247.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17534.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13372.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21416.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15705.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":16644.4},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15400.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15247.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":24929.78},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27334.96},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15247.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29243.99},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15247.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16010.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22871.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15705.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28474.57},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":15247.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15400.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15247.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","code_information":[{"code":"508","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8905.14,"maximum":20813.61,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19914.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13490.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14183.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12847.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20813.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12847.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15417.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11571.52},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9989.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12578.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13809.42},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12847.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14775.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8905.14},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14261.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13233.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11083.67},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Arthroscopy","code_information":[{"code":"509","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12119.85,"maximum":26503.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19303.94},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15748.78},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13595.31},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18794.55},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12119.85},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19409.33},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15084.82},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":22593.86},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24773.68},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26503.83},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25806.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","code_information":[{"code":"510","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19720.2,"maximum":43124.36,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39100.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26487.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31409.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25226.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40866.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25226.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":30271.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":25624.83},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22120.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24696.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30580.6},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25226.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29010.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19720.2},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31580.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25982.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":24544.5},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","code_information":[{"code":"511","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13533.66,"maximum":29595.56,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27111.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18366.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21555.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17491.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28336.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17491.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":20989.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":17585.91},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15181.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17124.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20986.98},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17491.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20115.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13533.66},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21673.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18016.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":16844.5},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11093.13,"maximum":24258.59,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21710.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14707.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17668.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14006.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22690.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14006.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":16808.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14414.64},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12443.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13712.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17202.39},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14006.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16107.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11093.13},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17765.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14426.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13806.93},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10387.95,"maximum":22716.49,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20677.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14007.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16545.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13340.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21611.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13340.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":16008.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13498.31},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11652.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13060.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16108.85},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13340.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15341.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10387.95},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16635.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13740.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12929.23},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13473.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13340.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":19365.25},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21233.57},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13340.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22716.49},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13340.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14007.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20010.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13740.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22118.81},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":13340.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13473.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13340.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7035.24,"maximum":15384.74,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13645.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9243.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11205.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8803.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14261.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8803.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10564.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9141.73},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7891.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8618.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10909.72},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8803.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10123.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7035.24},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11266.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9067.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8756.32},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21336.18,"maximum":46658.21,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41220.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27923.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33983.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26593.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43081.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26593.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":31912.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":27724.67},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23933.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26035.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33086.54},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26593.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30582.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21336.18},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34168.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27391.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":26555.81},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13880.04,"maximum":30353.03,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27095.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18354.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22107.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17480.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28318.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17480.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":20976.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":18036.01},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15569.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17113.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21524.12},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17480.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20102.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13880.04},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22228.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18005.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":17275.62},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17655.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17480.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":25875.21},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28371.61},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17480.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30353.03},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17480.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18354.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26221.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18005.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29554.43},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":17480.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17655.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17480.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"1 through 10","median_amount":58273.4,"10th_percentile":58273.4,"90th_percentile":58273.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10298.94,"maximum":22521.84,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20198.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13682.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16403.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13031.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21110.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13031.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15637.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13382.65},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11552.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12757.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15970.82},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13031.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14985.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10298.94},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16493.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13422.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12818.45},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13161.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13031.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":19199.31},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21051.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13031.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22521.84},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13031.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13682.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19546.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13422.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21929.28},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":13031.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13161.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13031.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"1 through 10","median_amount":85659.42,"10th_percentile":85659.42,"90th_percentile":85659.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24728.22,"maximum":54075.96,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48231.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32673.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39385.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31117.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50410.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31117.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":37340.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":32132.35},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27738.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30463.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38346.66},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31117.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35785.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24728.22},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39600.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32050.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":30777.67},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31428.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31117.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":46098.42},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":50545.92},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31117.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54075.96},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31117.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32673.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46676.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32050.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52653.19},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":31117.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31428.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31117.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15760.7,"10th_percentile":15760.7,"90th_percentile":15760.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26085.98,"10th_percentile":26085.98,"90th_percentile":26085.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Cc","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13604.73,"maximum":29750.98,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26102.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17682.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21668.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16840.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27281.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16840.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":20208.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":17678.26},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15260.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16486.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21097.19},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16840.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19366.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13604.73},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21787.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17345.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":16932.96},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17008.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16840.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":25361.98},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27808.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16840.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29750.98},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16840.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17682.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25260.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17345.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28968.22},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":16840.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17008.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16840.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15747.2,"10th_percentile":15747.2,"90th_percentile":15747.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16068.57,"10th_percentile":16068.57,"90th_percentile":16068.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9888.39,"maximum":21624.05,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19653.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13313.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15749.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12679.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20540.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12679.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15215.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":12849.17},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11092.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12413.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15334.17},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12679.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14581.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9888.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15835.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13059.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12307.46},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12806.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12679.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":18433.97},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20212.44},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12679.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21624.05},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12679.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13313.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19019.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13059.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21055.11},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":12679.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12806.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12679.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9996.79,"10th_percentile":9996.79,"90th_percentile":9996.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":45039.19,"10th_percentile":45039.19,"90th_percentile":45039.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20110.74,"maximum":43978.4,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37185.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25190.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32031.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23990.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38865.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23990.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":28789.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":26132.3},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22559.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23487.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31186.22},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23990.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27589.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20110.74},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32206.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24710.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":25030.58},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24230.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23990.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":37490.5},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":41107.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23990.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43978.4},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23990.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25190.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35986.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24710.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42821.3},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":23990.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24230.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23990.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14546.58,"maximum":31810.63,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27599.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18696.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23169.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17806.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28846.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17806.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":21367.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":18902.12},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16317.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17432.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22557.74},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17806.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20477.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14546.58},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23295.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18340.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":18105.22},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur With Mcc","code_information":[{"code":"533","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10521.12,"maximum":23007.71,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20593.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13950.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16757.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13285.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21523.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13285.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15943.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13671.36},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11801.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13006.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16315.36},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13285.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15278.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10521.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16849.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13684.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13094.98},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur Without Mcc","code_information":[{"code":"534","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5615.91,"maximum":12280.94,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10891.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7377.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8944.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7026.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11383.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7026.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8431.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7297.43},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6299.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6879.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8708.73},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7026.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8080.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5615.91},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8993.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7237.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6989.77},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7096.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7026.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":10469.2},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11479.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7026.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12280.94},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7026.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7377.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10539.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7237.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11957.82},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7026.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7096.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7026.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis With Mcc","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9176.31,"maximum":20066.86,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16953.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11484.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14615.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10937.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17719.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10937.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13125.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11923.88},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10293.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10708.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14229.93},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10937.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12578.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9176.31},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14695.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11266.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11421.18},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11047.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10937.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":17106.5},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18756.91},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10937.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20066.86},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10937.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11484.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16406.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11266.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19538.89},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":10937.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11047.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10937.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10366.54,"10th_percentile":10366.54,"90th_percentile":10366.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5595.21,"maximum":12235.67,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10910.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8911.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7038.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11402.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7038.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8446.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7270.53},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6276.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6891.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8676.63},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7038.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8094.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5595.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8960.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7250.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6964.01},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7109.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7038.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":10430.61},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11436.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7038.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12235.67},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7038.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10558.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7250.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11913.74},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7038.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7109.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7038.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6727.19,"10th_percentile":6727.19,"90th_percentile":6727.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","code_information":[{"code":"537","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6340.41,"maximum":13865.28,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12779.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8656.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10098.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8244.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13356.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8244.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9893.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8238.86},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7112.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8071.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9832.23},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8244.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9481.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6340.41},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10153.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8491.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7891.51},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8327.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8244.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11819.81},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12960.17},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8244.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13865.28},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8244.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8656.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12366.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8491.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13500.48},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8244.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8327.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8244.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","code_information":[{"code":"538","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4633.35,"maximum":10240.65,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9798.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6637.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7379.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6321.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10240.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6321.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7585.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6020.67},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5197.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6188.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7185.05},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6321.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7269.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4633.35},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7420.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6511.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5766.84},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Mcc","code_information":[{"code":"539","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13956.63,"maximum":30520.52,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25714.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17419.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22229.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16589.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26875.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16589.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":19907.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":18135.53},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15655.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16241.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21642.89},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16589.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19078.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13956.63},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22350.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17087.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":17370.95},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16755.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16589.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":26017.99},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28528.16},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16589.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30520.52},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16589.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17419.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24884.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17087.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29717.51},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":16589.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16755.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16589.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Cc","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8931.36,"maximum":19531.2,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17135.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11608.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14225.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11055.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17909.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11055.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13266.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11605.59},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10018.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10823.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13850.08},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11055.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12713.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8931.36},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14303.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11387.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11116.31},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11165.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11055.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":16649.87},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18256.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11055.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19531.2},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11055.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11608.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16583.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11387.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19017.32},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":11055.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11165.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11055.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis Without Cc/Mcc","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6036.12,"maximum":13199.86,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10652.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7216.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9614.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6872.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11134.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6872.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8247.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7843.46},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6770.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6728.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9360.36},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6872.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7903.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6036.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9666.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7079.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7512.78},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6941.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6872.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11252.55},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12338.18},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6872.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13199.86},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6872.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7216.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10309.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7079.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12852.56},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6872.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6941.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6872.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","code_information":[{"code":"542","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12867.81,"maximum":28139.48,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23125.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15665.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20495.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14919.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24170.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14919.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":17903.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":16720.69},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14434.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14606.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19954.43},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14919.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17157.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12867.81},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20607.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15367.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":16015.76},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15069.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14919.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":23988.21},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26302.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14919.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28139.48},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14919.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15665.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22379.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15367.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27399.11},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":14919.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15069.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14919.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":44070.24,"10th_percentile":44070.24,"90th_percentile":44070.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7319.52,"maximum":16006.41,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13717.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9292.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11658.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8850.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14337.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8850.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10620.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9511.13},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8210.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8664.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11350.56},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8850.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10177.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7319.52},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11721.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9115.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9110.15},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8938.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8850.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":13645.07},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14961.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8850.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16006.41},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8850.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9292.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13275.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9115.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15585.27},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8850.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8938.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8850.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8285.21,"10th_percentile":8285.21,"90th_percentile":8285.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"1 through 10","median_amount":14477.96,"10th_percentile":14477.96,"90th_percentile":14477.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"1 through 10","median_amount":9087.49,"10th_percentile":9087.49,"90th_percentile":9087.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5214.33,"maximum":11402.76,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10235.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6933.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8305.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6603.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10697.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6603.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7923.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6775.61},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5849.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6464.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8085.99},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6603.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7593.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5214.33},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8350.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6801.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6489.95},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Mcc","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17434.23,"maximum":38125.38,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32236.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21837.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27768.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20797.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33692.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20797.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":24957.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":22654.39},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19556.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20361.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27035.69},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20797.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23917.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17434.23},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27920.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21421.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":21699.3},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21005.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20797.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":32500.94},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":35636.58},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20797.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38125.38},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20797.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21837.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31196.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21421.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37122.28},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":20797.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21005.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20797.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Cc","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7988.13,"maximum":17468.54,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15315.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10374.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12723.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9880.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16007.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9880.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11857.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":10379.94},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8960.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9673.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12387.39},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9880.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11363.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7988.13},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12792.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10177.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9942.33},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9979.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9880.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":14891.5},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16328.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9880.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17468.54},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9880.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10374.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14821.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10177.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17008.93},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":9880.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9979.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9880.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9339.5,"10th_percentile":9339.5,"90th_percentile":9339.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"547","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5148.78,"maximum":11783.78,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11274.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7637.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8200.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7273.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11783.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7273.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8728.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6690.43},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5775.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7121.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7984.34},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7273.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8365.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5148.78},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8245.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7492.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6408.37},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7346.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7273.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":9598.37},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10524.4},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7273.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11259.41},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7273.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7637.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10910.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7492.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10963.17},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7273.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7346.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7273.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Mcc","code_information":[{"code":"548","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13900.05,"maximum":30396.79,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25220.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17084.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22139.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16271.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26359.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16271.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":19525.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":18062.01},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15592.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15929.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21555.15},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16271.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18711.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13900.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22260.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16759.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":17300.53},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16433.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16271.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":25912.51},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28412.51},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16271.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30396.79},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16271.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17084.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24406.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16759.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29597.03},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":16271.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16433.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16271.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Cc","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12606.99,"maximum":27569.11,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23595.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15984.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20079.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15223.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24661.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15223.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18267.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":16381.78},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14141.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14903.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19549.97},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15223.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17506.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12606.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20189.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15679.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15691.13},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15375.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15223.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":23501.99},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25769.42},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15223.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27569.11},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15223.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15984.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22834.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15679.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26843.75},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":15223.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15375.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15223.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26571.9,"maximum":58107.74,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48237.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32676.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42322.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31120.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50415.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31120.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":37344.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":34528.07},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":29806.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30467.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41205.7},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31120.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35788.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26571.9},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42553.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32054.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":33072.39},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31431.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31120.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":49535.41},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":54314.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31120.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58107.74},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31120.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32676.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46681.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32054.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":56578.89},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":31120.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31431.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31120.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12860.91,"maximum":28124.39,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25007.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16940.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20484.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16133.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26136.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16133.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":19360.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":16711.73},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14426.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15794.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19943.73},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16133.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18553.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12860.91},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20596.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16617.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":16007.17},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16295.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16133.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":23975.35},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26288.45},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16133.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28124.39},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16133.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16940.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24200.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16617.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27384.42},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":16133.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16295.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16133.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":91816.49,"10th_percentile":91816.49,"90th_percentile":91816.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17365.92,"maximum":37976.0,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32775.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22202.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27659.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21145.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34255.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21145.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":25374.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":22565.63},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19480.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20701.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26929.76},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21145.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24317.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17365.92},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27810.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21779.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":21614.28},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21357.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21145.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":32373.6},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":35496.95},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21145.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37976.0},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21145.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22202.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31718.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21779.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36976.83},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":21145.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21357.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21145.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Mcc","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31801.41,"maximum":69543.69,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57716.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39098.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50651.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37236.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60322.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37236.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":44683.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":41323.4},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":35672.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36454.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49315.23},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37236.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42821.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31801.41},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50928.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38353.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":39581.23},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37608.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37236.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":59284.28},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":65003.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37236.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":69543.69},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37236.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39098.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55854.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38353.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":67713.96},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":37236.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37608.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37236.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases Without Cc/Mcc","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4551.24,"maximum":10083.53,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9647.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6535.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7249.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6224.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10083.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6224.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7469.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":5913.97},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5105.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6093.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7057.72},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6224.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7158.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4551.24},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7288.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6411.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5664.64},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6286.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6224.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":8484.43},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9303.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6224.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9952.7},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6224.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6535.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9336.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6411.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9690.84},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6224.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6286.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6224.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6489.45,"maximum":14191.2,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12212.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8272.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10336.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7878.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12763.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7878.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9454.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8432.52},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7279.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7713.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10063.35},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7878.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9060.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6489.45},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10392.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8115.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8077.01},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7957.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7878.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":12097.65},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13264.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7878.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14191.2},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7878.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8272.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11818.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8115.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13817.83},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7878.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7957.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7878.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11298.06,"maximum":24706.73,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22492.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15236.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17995.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14511.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23508.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14511.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":17413.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14680.93},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12673.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14206.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17520.18},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14511.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16688.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11298.06},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18093.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14946.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14061.99},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4639.56,"maximum":10145.84,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9426.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6385.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7389.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6081.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9851.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6081.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7297.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6028.74},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5204.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5953.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7194.68},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6081.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6993.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4639.56},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7430.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6263.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5774.57},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6441.84,"maximum":14087.09,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12297.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8330.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10260.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7933.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12852.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7933.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9520.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8370.66},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7226.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7767.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9989.52},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7933.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9124.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6441.84},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10316.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8171.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8017.76},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8013.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7933.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":12008.9},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13167.49},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7933.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14087.09},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7933.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8330.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11900.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8171.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13716.45},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7933.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8013.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7933.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7437.55,"10th_percentile":7437.55,"90th_percentile":7437.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","code_information":[{"code":"154","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11220.78,"maximum":24537.73,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20539.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13914.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17871.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13251.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21467.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13251.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15901.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14580.51},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12586.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12973.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17400.34},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13251.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15239.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11220.78},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17969.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13648.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13965.81},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13383.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13251.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":20917.81},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22935.92},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13251.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24537.73},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13251.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13914.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19877.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13648.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23892.13},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":13251.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13383.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13251.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4910.73,"maximum":10738.84,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10026.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6791.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7821.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6468.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10478.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6468.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7762.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6381.1},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5508.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6332.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7615.19},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6468.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7438.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4910.73},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7864.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6662.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6112.08},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6533.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6468.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":9154.6},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10037.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6468.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10738.84},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6468.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6791.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9702.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6662.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10456.3},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6468.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6533.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6468.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":16095.06,"10th_percentile":16095.06,"90th_percentile":16095.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7829.43,"maximum":17121.49,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15682.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10623.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12470.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10117.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16390.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10117.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":12141.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":10173.72},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8782.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9905.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12141.29},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10117.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11635.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7829.43},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12538.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10421.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9744.8},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10218.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10117.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":14595.65},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16003.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10117.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17121.49},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10117.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10623.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15176.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10421.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16671.01},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":10117.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10218.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10117.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis Without Mcc","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5230.2,"maximum":11437.46,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9972.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6755.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8330.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6433.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10423.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6433.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7720.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6796.23},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5866.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6298.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8110.6},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6433.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7399.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5230.2},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8375.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6627.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6509.7},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6498.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6433.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":9750.15},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10690.83},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6433.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11437.46},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6433.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6755.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9650.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6627.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11136.54},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6433.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6498.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6433.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis With Mcc","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9536.49,"maximum":20854.51,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17584.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11911.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15189.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11344.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18378.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11344.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13613.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":12391.91},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10697.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11106.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14788.47},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11344.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13046.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9536.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15272.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11685.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11869.47},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11458.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11344.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":17777.95},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19493.14},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11344.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20854.51},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11344.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11911.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17017.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11685.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20305.81},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":11344.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11458.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11344.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5157.75,"maximum":11279.03,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10196.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6907.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8215.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6578.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10657.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6578.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7894.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6702.09},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5785.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6440.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7998.25},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6578.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7565.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5157.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8259.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6775.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6419.53},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5524.83,"maximum":12081.76,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10776.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7300.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8799.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6952.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11263.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6952.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8343.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7179.08},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6197.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6806.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8567.49},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6952.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7995.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5524.83},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8847.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7161.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6876.41},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Cc","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8588.43,"maximum":18781.28,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16819.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11394.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13679.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10851.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17579.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10851.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13021.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11159.98},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9633.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10623.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13318.29},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10851.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12479.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8588.43},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13753.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11177.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10689.48},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10960.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10851.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":16010.58},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17555.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10851.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18781.28},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10851.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11394.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16277.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11177.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18287.13},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":10851.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10960.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10851.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Mcc","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15827.91,"maximum":34612.66,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27595.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18694.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25209.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17803.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28842.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17803.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":21364.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":20567.11},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17754.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17429.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24544.73},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17803.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20474.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15827.91},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25347.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18337.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":19700.01},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17981.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17803.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":29506.44},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":32353.17},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17803.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34612.66},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17803.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18694.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26705.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18337.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33701.98},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":17803.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17981.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17803.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16646.85,"10th_percentile":16646.85,"90th_percentile":16646.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8174.43,"maximum":17875.94,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15938.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10796.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13019.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10282.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16658.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10282.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":12339.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":10622.02},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9169.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10066.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12676.29},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10282.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11825.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8174.43},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13090.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10591.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10174.2},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","code_information":[{"code":"144","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12120.54,"maximum":26505.34,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22697.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15375.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19305.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14643.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23722.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14643.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":17572.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15749.68},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13596.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14336.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18795.62},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14643.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16840.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12120.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19410.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15083.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15085.68},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14790.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14643.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":22595.15},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24775.09},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14643.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26505.34},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14643.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15375.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21965.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15083.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25807.97},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":14643.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14790.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14643.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10848.87,"maximum":23724.43,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20958.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14197.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17279.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13521.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21905.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13521.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":16226.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14097.24},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12169.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13237.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16823.61},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13521.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15550.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10848.87},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17373.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13927.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13502.91},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Cc","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14823.27,"maximum":32415.7,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28407.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19243.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23609.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18327.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29690.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18327.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":21992.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":19261.66},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16627.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17942.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22986.81},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18327.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21076.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14823.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23738.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18877.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":18449.6},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18510.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18327.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":27633.58},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30299.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18327.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32415.7},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18327.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19243.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27491.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18877.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31562.82},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":18327.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18510.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18327.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Mcc","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29180.1,"maximum":63811.38,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54958.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37229.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46476.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35456.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57440.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35456.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":42548.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":37917.21},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":32732.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34712.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45250.3},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35456.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40775.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29180.1},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46730.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36520.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":36318.65},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35811.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35456.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":54397.63},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":59645.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35456.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":63811.38},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35456.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37229.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53185.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36520.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":62132.47},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":35456.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35811.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35456.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9473.01,"maximum":20715.69,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16363.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11085.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15088.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10557.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17102.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10557.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":12668.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":12309.42},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10626.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10335.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14690.03},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10557.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12140.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9473.01},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15170.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10874.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11790.47},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10662.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10557.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":17659.61},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19363.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10557.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20715.69},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10557.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11085.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15836.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10874.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20170.65},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":10557.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10662.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10557.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures Without Cc/Mcc","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5613.15,"maximum":12449.51,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11911.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8069.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8940.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7684.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12449.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7684.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9221.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7293.84},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6296.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7523.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8704.45},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7684.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8837.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5613.15},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8989.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7915.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6986.34},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7761.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7684.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":10464.05},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11473.6},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7684.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12274.9},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7684.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8069.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11527.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7915.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11951.94},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7684.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7761.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7684.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures With Cc/Mcc","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9649.65,"maximum":21101.97,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19644.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13307.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15369.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12673.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20531.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12673.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15208.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":12538.95},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10824.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12407.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14963.95},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12673.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14574.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9649.65},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15453.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13053.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12010.32},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12800.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12673.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":17988.91},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19724.44},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12673.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21101.97},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12673.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13307.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19010.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13053.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20546.76},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":12673.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12800.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12673.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures Without Cc/Mcc","code_information":[{"code":"136","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6749.58,"maximum":14760.06,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13556.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9183.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10750.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14168.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10495.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8770.54},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7571.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8562.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10466.74},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10057.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6749.58},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10809.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9008.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8400.78},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8833.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":12582.59},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13796.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14760.06},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9183.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13118.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9008.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14371.71},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8745.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8833.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures With Cc/Mcc","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16635.21,"maximum":36378.07,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28266.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19147.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26495.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18236.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29542.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18236.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":21883.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":21616.13},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18660.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17853.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25796.63},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18236.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20971.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16635.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26640.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18783.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":20704.81},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5697.33,"maximum":12458.99,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10403.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7047.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9074.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6711.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10873.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6711.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8054.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7403.23},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6390.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6570.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8834.99},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6711.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7718.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5697.33},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9123.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6913.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7091.11},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8996.22,"maximum":19673.04,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17477.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11839.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14328.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11275.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18266.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11275.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13530.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11689.87},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10091.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11038.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13950.66},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11275.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12967.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8996.22},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14406.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11613.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11197.03},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5542.08,"maximum":12119.48,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10795.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7313.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8827.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11283.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8357.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7201.49},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6216.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6818.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8594.24},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8009.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5542.08},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8875.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7173.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6897.88},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4680.27,"maximum":11112.73,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10632.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7202.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7454.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6859.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11112.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6859.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8231.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6081.64},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5250.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6715.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7257.81},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6859.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7888.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4680.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7495.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7065.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5825.24},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections With Cc/Mcc","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8025.39,"maximum":17550.02,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15441.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10460.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12782.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9962.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16138.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9962.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11954.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":10428.35},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9002.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9753.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12445.17},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9962.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11456.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8025.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12852.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10261.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9988.7},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures Without Cc/Mcc","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7442.34,"maximum":16275.0,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14442.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9783.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11853.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9317.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15095.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9317.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11181.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9670.73},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8348.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9122.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11541.02},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9317.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10715.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.34},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11918.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9597.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9263.02},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9411.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9317.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":13874.03},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15212.57},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9317.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16275.0},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9317.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9783.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13976.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9597.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15846.79},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":9317.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9411.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9317.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures With Cc/Mcc","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11512.65,"maximum":25176.0,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23655.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16024.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18336.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15261.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24724.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15261.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18314.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14959.77},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12914.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14941.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17852.95},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15261.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17551.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11512.65},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18436.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15719.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14329.08},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15414.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15261.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":21461.92},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23532.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15261.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25176.0},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15261.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16024.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22892.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15719.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24513.6},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":15261.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15414.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15261.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extraocular Procedures Except Orbit","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10563.21,"maximum":23099.75,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20175.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13667.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16824.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13016.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21086.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13016.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15619.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13726.05},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11849.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12743.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16380.63},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13016.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14968.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10563.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16916.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13406.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13147.37},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13146.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13016.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":19691.97},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21591.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13016.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23099.75},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13016.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13667.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19524.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13406.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22491.98},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":13016.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13146.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13016.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures Without Cc/Mcc","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8156.49,"maximum":18664.67,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17858.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12097.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12991.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11521.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18664.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11521.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13825.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":10598.71},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9149.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11279.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12648.47},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11521.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13249.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8156.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13062.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11867.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10151.87},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11636.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11521.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":15205.35},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16672.34},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11521.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17836.71},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11521.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12097.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17282.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11867.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17367.41},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":11521.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11636.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11521.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6083.04,"maximum":13302.46,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11633.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7881.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9688.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7505.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12159.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7505.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9006.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7904.43},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6823.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7348.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9433.12},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7505.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8631.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6083.04},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9741.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7730.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7571.18},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7580.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7505.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11340.02},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12434.09},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7505.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13302.46},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7505.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7881.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11258.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7730.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12952.47},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7505.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7580.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7505.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5521.38,"maximum":12074.22,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10798.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7314.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8794.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6966.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11285.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6966.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8359.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7174.59},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6193.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6820.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8562.14},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6966.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8011.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5521.38},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8842.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6872.12},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7036.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6966.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":10292.97},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11286.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6966.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12074.22},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6966.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7314.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10449.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11756.54},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6966.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7036.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6966.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11997.03,"maximum":26235.24,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21830.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14788.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19108.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14084.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22816.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14084.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":16900.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15589.18},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13457.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13788.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18604.09},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14084.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16196.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11997.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19212.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14506.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14931.96},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14224.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14084.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":22364.9},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24522.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14084.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26235.24},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14084.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14788.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21126.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14506.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25544.98},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":14084.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14224.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14084.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7271.22,"maximum":15900.79,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13692.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9275.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11581.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8833.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14310.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8833.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10600.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9448.37},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8156.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8648.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11275.66},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8833.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10158.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7271.22},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11644.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9098.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9050.03},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8922.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8833.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":13555.03},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14862.8},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8833.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15900.79},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8833.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9275.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13250.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9098.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15482.43},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8833.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8922.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8833.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5175.69,"maximum":11318.26,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10255.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6947.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8243.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6616.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10718.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6616.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7939.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6725.4},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5805.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6477.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8026.07},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6616.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7608.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5175.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8288.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6441.86},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6682.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6616.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":9648.54},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10579.41},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6616.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11318.26},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6616.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6947.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9924.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11020.47},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6616.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6682.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6616.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"1 through 10","median_amount":14361.07,"10th_percentile":14361.07,"90th_percentile":14361.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10663.95,"maximum":23320.05,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21059.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14266.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16985.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13586.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22010.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13586.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":16304.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13856.95},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11962.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13301.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16536.85},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13586.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15624.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10663.95},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17077.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13994.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13272.75},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13722.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13586.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":19879.77},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21797.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13586.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23320.05},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13586.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14266.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20380.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13994.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22706.49},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":13586.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13722.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13586.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7192.56,"maximum":15728.77,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13753.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9316.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11455.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8873.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14374.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8873.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10647.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9346.16},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8068.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8686.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11153.68},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8873.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10204.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7192.56},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11518.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9139.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8952.13},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8962.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8873.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":13408.39},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14702.01},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8873.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15728.77},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8873.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9316.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13309.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9139.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15314.94},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8873.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8962.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8873.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8305.94,"10th_percentile":8305.94,"90th_percentile":8305.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4056.75,"10th_percentile":4056.75,"90th_percentile":4056.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":5958.92,"10th_percentile":5958.92,"90th_percentile":5958.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4056.75,"10th_percentile":4056.75,"90th_percentile":4056.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11884.56,"maximum":26180.64,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25049.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16968.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18929.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16160.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26180.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16160.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":19393.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15443.04},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13331.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15821.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18429.68},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16160.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18585.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11884.56},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19032.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16645.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14791.97},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16322.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16160.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":22155.23},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24292.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16160.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25989.29},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16160.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16968.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24241.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16645.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25305.5},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":16160.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16322.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16160.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6326.61,"maximum":13835.1,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11134.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7542.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10076.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7183.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11637.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7183.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8620.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8220.93},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7096.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7032.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9810.83},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7183.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8261.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6326.61},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10131.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7399.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7874.34},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7255.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7183.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11794.08},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12931.96},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7183.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13835.1},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7183.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7542.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10775.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7399.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13471.09},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7183.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7255.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7183.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10668.78,"maximum":23330.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16992.74},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13863.23},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11967.59},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16544.34},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10668.78},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17085.51},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13278.77},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":19888.77},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21807.6},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23330.61},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22716.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Cc","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6884.82,"maximum":15055.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10965.82},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8946.27},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7722.97},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10676.46},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6884.82},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11025.69},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8569.11},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":12834.7},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14072.97},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15055.8},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14659.68}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy Without Cc/Mcc","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4600.23,"maximum":10059.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7327.03},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":5977.63},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5160.26},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7133.69},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4600.23},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7367.04},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5725.62},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":8575.76},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9403.14},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10059.84},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9795.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13715.82,"maximum":29993.91,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23679.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16041.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21845.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15277.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24749.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15277.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18332.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":17822.61},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15385.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14956.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21269.46},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15277.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17568.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13715.82},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21965.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15735.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":17071.23},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15430.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15277.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":25569.07},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28035.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15277.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29993.91},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15277.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16041.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22916.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15735.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29204.76},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":15277.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15430.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15277.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6243.12,"maximum":13652.53,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12031.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8150.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9943.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7762.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12574.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7762.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9314.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8112.44},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7003.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7599.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9681.36},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7762.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8926.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6243.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9998.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7995.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7770.42},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7839.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7762.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11638.44},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12761.3},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7762.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13652.53},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7762.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8150.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11643.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7995.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13293.32},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7762.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7839.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7762.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16008.69,"maximum":35007.99,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29738.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20145.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25497.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19186.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31081.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19186.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":23023.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":20802.02},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17957.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18783.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24825.07},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19186.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22064.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16008.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25637.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19761.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":19925.02},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19378.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19186.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":29843.45},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":32722.69},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19186.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35007.99},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19186.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20145.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28779.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19761.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34086.91},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":19186.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19378.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19186.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9593.07,"maximum":20978.24,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18403.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12466.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15279.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11873.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19234.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11873.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":14247.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":12465.43},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10760.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11623.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14876.21},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11873.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13654.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9593.07},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15362.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12229.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11939.9},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11991.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11873.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":17883.43},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19608.79},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11873.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20978.24},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11873.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12466.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17809.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12229.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20426.29},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":11873.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11991.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11873.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11519.06,"10th_percentile":11519.06,"90th_percentile":11519.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6596.4,"maximum":14425.08,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12798.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8669.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10506.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8256.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13376.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8256.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9908.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8571.5},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7399.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8083.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10229.2},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8256.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9495.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6596.4},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10563.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8210.13},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8339.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8256.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":12297.03},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13483.42},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8256.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14425.08},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8256.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8669.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12385.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14045.55},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8256.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8339.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8256.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11519.06,"10th_percentile":11519.06,"90th_percentile":11519.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":11824.95,"10th_percentile":11824.95,"90th_percentile":11824.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11235.21,"10th_percentile":11235.21,"90th_percentile":11235.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15634.71,"maximum":34190.17,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29564.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20027.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24902.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19073.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30899.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19073.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":22888.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":20316.06},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17538.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18673.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24245.13},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19073.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21934.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15634.71},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25038.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19645.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":19459.55},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19264.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19073.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":29146.27},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31958.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19073.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34190.17},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19073.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20027.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28610.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19645.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33290.6},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":19073.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19264.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19073.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"1 through 10","median_amount":47030.72,"10th_percentile":47030.72,"90th_percentile":47030.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9050.04,"maximum":19790.73,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17217.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11663.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14414.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11107.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17994.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11107.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13329.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11759.81},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10151.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10874.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14034.12},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11107.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12774.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9050.04},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14493.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11441.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11264.02},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11219.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11107.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":16871.11},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18498.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11107.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19790.73},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11107.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11663.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16661.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11441.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19270.03},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":11107.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11219.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11107.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6099.6,"maximum":13338.68,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12274.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8315.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9715.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7919.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12828.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7919.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9502.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7925.94},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6842.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7752.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9458.8},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7919.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9106.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6099.6},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9768.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8156.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7591.79},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7998.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7919.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11370.89},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12467.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7919.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13338.68},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7919.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8315.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11878.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8156.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12987.73},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7919.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7998.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7919.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Mcc","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9733.14,"maximum":21284.54,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17842.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12087.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15502.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11511.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18648.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11511.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13813.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":12647.44},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10918.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11269.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15093.42},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11511.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13238.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9733.14},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15587.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11856.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12114.23},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Cc","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7397.49,"maximum":16176.92,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14617.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9902.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11782.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9430.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15277.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9430.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11316.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9612.45},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8298.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9232.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11471.47},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9430.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10845.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7397.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11846.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9207.19},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Cc","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8314.5,"maximum":18182.25,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16000.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10839.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13242.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10323.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16723.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10323.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":12387.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":10804.03},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9326.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10106.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12893.5},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10323.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11871.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8314.5},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13315.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10632.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10348.54},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10426.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10323.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":15499.92},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16995.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10323.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18182.25},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10323.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10839.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15484.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10632.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17703.86},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":10323.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10426.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10323.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis Without Cc/Mcc","code_information":[{"code":"550","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5948.49,"maximum":13008.23,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11757.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7964.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9474.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7585.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12288.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7585.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9102.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7729.59},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6672.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7426.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9224.47},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7585.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8723.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5948.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9526.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7812.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7403.71},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7661.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7585.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11089.19},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12159.06},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7585.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13008.23},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7585.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7964.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11378.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7812.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12665.97},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7585.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7661.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7585.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11773.47,"maximum":25746.36,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21974.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14885.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18752.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14176.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22966.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14176.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":17012.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15298.69},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13206.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13879.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18257.41},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14176.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16303.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11773.47},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18854.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14602.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14653.7},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14318.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14176.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":21948.14},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24065.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14176.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25746.36},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14176.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14885.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21265.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14602.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25068.96},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":14176.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14318.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14176.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13259.36,"10th_percentile":13259.36,"90th_percentile":13259.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6650.22,"maximum":14542.78,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12868.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8717.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10592.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8302.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13449.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8302.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9962.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8641.43},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7459.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8127.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10312.66},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8302.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9547.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6650.22},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10649.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8551.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8277.11},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8385.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8302.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":12397.36},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13593.44},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8302.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14542.78},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8302.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8717.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12453.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8551.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14160.15},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8302.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8385.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8302.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3965.71,"10th_percentile":3965.71,"90th_percentile":3965.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":23214.03,"10th_percentile":23214.03,"90th_percentile":30636.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7795.86,"10th_percentile":7795.86,"90th_percentile":7795.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"1 through 10","median_amount":14709.24,"10th_percentile":14709.24,"90th_percentile":14709.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Bone Diseases And Arthropathies With Mcc","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9013.47,"maximum":19710.76,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17135.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11608.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14356.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11055.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17909.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11055.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13266.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11712.29},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10110.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10823.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13977.41},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11055.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12713.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9013.47},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14434.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11387.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11218.5},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11165.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11055.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":16802.94},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18424.06},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11055.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19710.76},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11055.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11608.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16583.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11387.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19192.16},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":11055.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11165.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11055.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies Without Mcc","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5758.74,"maximum":12593.28,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11196.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7585.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9172.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7223.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11702.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7223.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8668.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7483.02},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6459.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7072.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8930.22},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7223.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8307.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5758.74},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9222.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7440.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7167.54},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7296.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7223.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":10735.46},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11771.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7223.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12593.28},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7223.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7585.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10835.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7440.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12261.94},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7223.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7296.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7223.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9290.85,"maximum":20317.34,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17460.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11828.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14798.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11264.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18249.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11264.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13517.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":12072.72},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10421.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11028.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14407.55},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11264.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12954.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9290.85},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14878.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11602.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11563.74},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11377.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11264.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":17320.03},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18991.04},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11264.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20317.34},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11264.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11828.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16897.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11602.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19782.78},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":11264.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11377.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11264.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5633.85,"maximum":12320.17,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11203.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7589.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8973.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11709.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8673.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7320.74},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6319.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7076.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8736.55},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8312.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5633.85},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9022.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7444.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7012.1},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7300.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":10502.64},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11515.92},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12320.17},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7589.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10841.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7444.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11996.02},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7227.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7300.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4023.49,"10th_percentile":4023.49,"90th_percentile":4023.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10692.93,"maximum":23383.42,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19563.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13252.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17031.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12621.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20447.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12621.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15146.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13894.61},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11994.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12356.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16581.79},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12621.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14515.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10692.93},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17124.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13000.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13308.82},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12748.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12621.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":19933.79},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21856.97},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12621.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23383.42},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12621.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13252.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18932.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13000.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22768.19},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":12621.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12748.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12621.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5960.22,"maximum":13033.88,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12000.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8129.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9493.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7742.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12542.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7742.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9290.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7744.83},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6685.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7579.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9242.66},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7742.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8903.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5960.22},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9544.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7974.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7418.31},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7819.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7742.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11111.06},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12183.04},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7742.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13033.88},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7742.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8129.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11613.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7974.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12690.95},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7742.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7819.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7742.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12807.09,"maximum":28006.69,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24379.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16515.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20398.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15728.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25480.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15728.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18874.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":16641.79},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14366.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15398.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19860.27},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15728.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18087.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12807.09},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20509.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16200.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15940.19},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15885.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15728.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":23875.01},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26178.43},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15728.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28006.69},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15728.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16515.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23592.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16200.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27269.82},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":15728.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15885.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15728.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7857.72,"maximum":17183.35,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14967.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10139.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12515.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9656.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15643.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9656.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11587.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":10210.48},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8814.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9453.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12185.16},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9656.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11105.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7857.72},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12583.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9946.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9780.01},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5641.44,"maximum":12336.77,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10863.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7358.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8985.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7008.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11353.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7008.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8410.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7330.6},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6328.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6861.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8748.32},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7008.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8059.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5641.44},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9034.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7218.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7021.55},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10099.53,"maximum":22085.77,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18772.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12717.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16086.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12111.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19620.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12111.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":14533.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13123.53},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11329.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11857.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15661.59},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12111.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13928.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10099.53},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16173.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12474.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12570.26},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6166.53,"maximum":13485.04,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12030.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8149.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9821.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7761.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12573.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7761.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9313.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8012.91},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6917.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7598.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9562.59},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7761.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8925.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6166.53},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9875.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7994.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7675.1},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10827.48,"maximum":23677.66,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20286.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13742.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17245.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13087.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21202.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13087.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15705.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14069.45},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12145.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12813.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16790.44},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13087.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15051.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10827.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17339.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13480.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13476.29},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13218.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13087.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":20184.62},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22132.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13087.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23677.66},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13087.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13742.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19631.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13480.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23054.69},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":13087.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13218.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13087.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7035.24,"maximum":15384.74,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13035.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11205.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8409.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13623.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8409.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10091.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9141.73},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7891.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8233.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10909.72},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8409.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9671.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7035.24},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11266.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8662.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8756.32},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8493.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8409.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":13115.11},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14380.44},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8409.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15384.74},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8409.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12614.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8662.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14979.96},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8409.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8493.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8409.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":19131.12,"10th_percentile":19131.12,"90th_percentile":19131.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5161.2,"maximum":11286.57,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10167.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6887.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8220.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6559.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10626.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6559.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7871.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6706.57},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5789.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6421.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8003.6},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6559.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7543.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5161.2},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8265.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6756.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6423.82},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20771.76,"maximum":45423.93,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38089.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25802.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33084.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24573.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39809.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24573.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":29488.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":26991.25},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23300.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24057.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32211.28},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24573.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28259.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20771.76},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33264.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25310.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":25853.32},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11556.12,"maximum":25271.06,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22144.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15001.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18406.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14287.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23144.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14287.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":17144.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15016.26},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12962.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13986.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17920.36},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14287.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16430.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11556.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18506.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14715.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14383.18},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14429.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14287.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":21542.95},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23621.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14287.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25271.06},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14287.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15001.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21430.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14715.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24606.16},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":14287.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14429.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14287.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement Without Cc/Mcc","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7882.56,"maximum":17237.67,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15225.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10313.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12554.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9822.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15912.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9822.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11787.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":10242.76},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8842.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9616.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12223.68},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9822.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11295.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7882.56},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12623.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10117.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9810.93},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"573","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42488.82,"maximum":92915.04,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84081.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56958.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67674.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54245.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87878.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54245.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":65094.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":55210.83},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":47661.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53106.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":65888.46},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54245.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62382.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42488.82},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68043.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55873.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":52883.19},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"574","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23906.43,"maximum":52278.86,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44844.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30378.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38077.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28932.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46869.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28932.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":34718.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":31064.5},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26816.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28324.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37072.29},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28932.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33271.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23906.43},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38284.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29799.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":29754.84},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"575","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13775.85,"maximum":30125.19,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23514.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15929.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21941.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15170.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24576.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15170.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18204.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":17900.62},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15452.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14851.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21362.55},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15170.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17446.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13775.85},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22061.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15625.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":17145.94},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15322.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15170.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":25680.98},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28158.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15170.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30125.19},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15170.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15929.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22755.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15625.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29332.58},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":15170.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15322.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15170.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"576","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37224.81,"maximum":81403.65,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63058.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42717.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59289.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40683.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65906.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40683.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":48819.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":48370.67},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":41756.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39828.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":57725.43},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40683.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46785.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37224.81},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59613.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41903.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":46331.4},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"577","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18371.94,"maximum":40175.97,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34389.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23296.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29261.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22186.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35942.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22186.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":26624.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":23872.87},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20608.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21720.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28489.82},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22186.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25514.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18371.94},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29421.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22852.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":22866.41},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"578","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11663.07,"maximum":25504.94,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21086.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14284.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18576.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13604.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22038.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13604.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":16324.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15155.23},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13082.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13318.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18086.21},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13604.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15644.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11663.07},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18677.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14012.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14516.3},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22487.79,"maximum":49176.56,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41877.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28368.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35817.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27017.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43768.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27017.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":32421.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":29221.09},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25225.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26450.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34872.37},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27017.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31070.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22487.79},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36013.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27828.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":27989.15},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","code_information":[{"code":"580","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12233.01,"maximum":26751.29,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22635.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15333.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19484.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14603.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23657.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14603.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":17524.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15895.82},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13722.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14296.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18970.03},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14603.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16793.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12233.01},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19590.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15041.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15225.67},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14749.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14603.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":22804.81},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25004.98},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14603.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26751.29},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14603.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15333.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21905.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15041.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26047.45},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":14603.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14749.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14603.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5013.36,"10th_percentile":5013.36,"90th_percentile":5013.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","code_information":[{"code":"581","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9929.79,"maximum":21714.58,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19005.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12875.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15815.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12261.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19864.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12261.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":14714.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":12902.97},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11138.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12004.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15398.37},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12261.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14101.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9929.79},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15902.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12629.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12358.99},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy With Cc/Mcc","code_information":[{"code":"582","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12082.59,"maximum":26422.35,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25165.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17047.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19244.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16235.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26301.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16235.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":19482.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15700.36},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13553.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15894.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18736.77},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16235.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18671.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12082.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19349.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16722.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15038.45},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy Without Cc/Mcc","code_information":[{"code":"583","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11333.25,"maximum":24783.68,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22589.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15302.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18051.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14573.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23609.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14573.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":17488.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14726.66},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12712.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14267.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17574.75},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14573.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16759.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11333.25},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18149.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15011.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14105.79},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14719.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14573.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":21127.48},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23165.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14573.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24783.68},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14573.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15302.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21860.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15011.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24131.61},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":14573.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14719.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14573.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","code_information":[{"code":"584","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14126.37,"maximum":30891.71,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27892.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18895.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22499.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17995.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29152.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17995.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":21594.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":18356.09},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15846.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17617.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21906.11},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17995.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20694.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14126.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22622.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18535.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":17582.21},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18175.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17995.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":26334.42},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28875.12},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17995.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30891.71},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17995.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18895.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26992.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18535.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30078.93},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":17995.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18175.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17995.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","code_information":[{"code":"585","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13696.5,"maximum":29951.67,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25197.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17069.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21815.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16256.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26335.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16256.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":19507.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":17797.51},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15363.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15914.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21239.5},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16256.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18694.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13696.5},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21934.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16743.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":17047.18},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Mcc","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14187.78,"maximum":31026.0,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25276.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17122.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22597.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16307.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26417.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16307.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":19568.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":18435.89},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15914.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15964.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22001.34},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16307.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18753.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14187.78},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22721.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16796.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":17658.65},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9499.59,"10th_percentile":9499.59,"90th_percentile":9499.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Cc","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8435.94,"maximum":18447.81,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15734.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10658.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13436.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10151.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16445.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10151.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":12181.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":10961.83},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9462.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9938.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13081.82},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10151.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11674.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8435.94},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13509.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10455.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10499.69},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10252.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10151.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":15726.3},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17243.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10151.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18447.81},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10151.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10658.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15227.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10455.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17962.44},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":10151.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10252.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10151.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers Without Cc/Mcc","code_information":[{"code":"594","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5855.34,"maximum":12804.53,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11664.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7901.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9326.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7525.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12191.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7525.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9030.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7608.55},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6568.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7367.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9080.02},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7525.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8654.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5855.34},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9377.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7751.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7287.78},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7600.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7525.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":10915.54},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11968.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7525.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12804.53},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7525.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7901.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11288.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7751.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12467.63},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7525.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7600.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7525.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders With Mcc","code_information":[{"code":"595","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14593.5,"maximum":31913.24,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27637.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18722.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23243.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17830.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28886.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17830.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":21397.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":18963.09},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16370.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17456.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22630.5},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17830.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20505.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14593.5},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23370.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18365.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":18163.62},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders Without Mcc","code_information":[{"code":"596","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7458.9,"maximum":16311.21,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14412.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9763.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11880.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9298.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15063.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9298.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11157.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9692.25},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8366.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9102.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11566.7},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9298.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10692.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7458.9},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11945.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9577.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9283.63},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9391.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9298.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":13904.9},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15246.42},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9298.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16311.21},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9298.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9763.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13947.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9577.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15882.05},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":9298.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9391.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9298.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Mcc","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12119.85,"maximum":26503.83,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21859.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14808.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19303.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14102.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22846.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14102.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":16923.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15748.78},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13595.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13806.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18794.55},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14102.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16218.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12119.85},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19409.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14526.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15084.82},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Cc","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7444.41,"maximum":16279.52,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15033.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10184.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11857.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9699.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15712.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9699.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11639.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9673.42},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8350.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9495.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11544.23},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9699.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11154.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7444.41},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11921.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9990.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9265.59},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"599","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5898.81,"maximum":12899.59,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10423.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7061.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9395.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6724.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10894.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6724.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8069.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7665.03},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6616.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6583.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9147.43},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6724.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7733.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5898.81},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9446.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6926.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7341.88},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders With Cc/Mcc","code_information":[{"code":"600","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6604.68,"maximum":14518.55,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13891.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9410.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10519.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8962.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14518.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8962.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10754.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8582.26},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7408.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8773.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10242.04},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8962.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10306.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6604.68},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10577.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9230.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8220.43},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"601","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4136.55,"maximum":9045.86,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8329.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5642.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6588.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5373.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8705.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5373.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":6448.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":5375.12},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":4640.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5260.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6414.65},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5373.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6179.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4136.55},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6624.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5534.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5148.51},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10138.86,"maximum":22171.78,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18728.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12686.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16148.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12082.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19574.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12082.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":14499.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13174.64},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11373.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11829.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15722.58},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12082.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13895.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10138.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16236.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12445.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12619.21},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12203.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12082.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":18900.89},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20724.42},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12082.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22171.78},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12082.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12686.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18124.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12445.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21588.42},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":12082.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12203.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12082.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11534.16,"10th_percentile":11534.16,"90th_percentile":11534.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6078.21,"maximum":13291.9,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11716.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7937.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9681.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7559.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12245.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7559.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9070.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7898.15},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6818.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7400.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9425.63},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7559.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8693.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6078.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9733.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7785.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7565.17},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7634.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7559.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11331.02},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12424.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7559.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13291.9},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7559.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7937.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11338.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7785.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12942.18},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7559.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7634.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7559.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7078.53,"10th_percentile":7078.53,"90th_percentile":7078.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":30533.88,"10th_percentile":30533.88,"90th_percentile":30533.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10251.33,"maximum":22417.73,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19375.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13125.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16327.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12500.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20250.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12500.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15000.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13320.79},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11499.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12237.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15896.99},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12500.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14375.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10251.33},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16416.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12875.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12759.19},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12625.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12500.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":19110.56},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20954.31},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12500.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22417.73},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12500.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13125.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18750.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12875.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21827.9},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":12500.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12625.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12500.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6373.53,"maximum":13937.71,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12291.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8326.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10151.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7929.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12846.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7929.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9515.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8281.89},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7149.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7763.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9883.59},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7929.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9119.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6373.53},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10206.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8167.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7932.74},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8009.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7929.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11881.55},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13027.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7929.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13937.71},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7929.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8326.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11894.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8167.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13571.0},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7929.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8009.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7929.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12744.52,"10th_percentile":12744.52,"90th_percentile":12744.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders With Mcc","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11109.69,"maximum":24294.8,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19898.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13479.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17695.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12838.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20797.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12838.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15405.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14436.16},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12462.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12568.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17228.07},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12838.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14763.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11109.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17791.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13223.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13827.54},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12966.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12838.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":20710.72},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22708.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12838.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24294.8},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12838.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13479.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19257.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13223.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23655.59},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":12838.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12966.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12838.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders Without Mcc","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5963.67,"maximum":13041.42,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12168.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8243.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9498.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7850.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12718.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7850.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9421.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7749.31},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6689.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7686.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9248.01},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7850.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9028.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5963.67},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9550.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8086.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7422.61},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures With Cc/Mcc","code_information":[{"code":"614","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15723.72,"maximum":34384.81,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28543.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19336.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25044.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18415.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29832.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18415.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":22098.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":20431.72},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17637.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18028.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24383.16},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18415.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21177.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15723.72},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25180.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18967.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":19570.33},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures Without Cc/Mcc","code_information":[{"code":"615","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9887.01,"maximum":21621.03,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18447.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12497.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15747.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11901.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19281.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11901.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":14282.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":12847.38},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11090.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11651.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15332.03},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11901.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13687.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9887.01},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15833.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12258.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12305.75},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"616","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26667.81,"maximum":58317.48,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45048.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30516.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42475.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29063.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47082.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29063.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":34876.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":34652.69},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":29914.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28453.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41354.43},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29063.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33423.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26667.81},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42707.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29935.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":33191.76},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13332.18,"maximum":29154.97,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24448.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16561.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21234.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15772.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25552.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15772.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18927.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":17324.11},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14955.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15441.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20674.54},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15772.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18138.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13332.18},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21350.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16246.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":16593.73},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"618","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8590.5,"maximum":19534.09,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18690.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12660.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13682.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12058.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19534.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12058.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":14469.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11162.67},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9636.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11804.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13321.5},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12058.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13866.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8590.5},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13757.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12419.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10692.06},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Cc","code_information":[{"code":"620","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11018.61,"maximum":24095.62,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21008.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14231.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17549.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13553.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21957.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13553.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":16264.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14317.81},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12360.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13269.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17086.83},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13553.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15586.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11018.61},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17645.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13960.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13714.18},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity Without Cc/Mcc","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10085.73,"maximum":22055.59,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19837.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13438.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16064.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12798.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20733.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12798.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15358.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13105.6},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11313.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12529.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15640.19},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12798.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14718.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10085.73},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16151.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13182.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12553.08},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25833.6,"maximum":56493.22,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45963.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31136.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41146.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29653.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48038.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29653.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":35584.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":33568.7},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28978.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29030.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40060.8},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29653.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34101.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25833.6},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41371.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30543.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":32153.47},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13206.6,"maximum":28880.35,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23474.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15902.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21034.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15145.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24534.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15145.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18174.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":17160.92},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14814.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14827.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20479.8},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15145.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17416.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13206.6},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21149.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15599.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":16437.43},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1580.0,"10th_percentile":1580.0,"90th_percentile":1580.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"624","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6921.39,"maximum":17318.58,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16570.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11225.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11024.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10690.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17318.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10690.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":12828.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8993.79},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7763.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10465.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10733.17},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10690.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12294.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6921.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11084.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11011.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8614.62},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19781.61,"maximum":43258.65,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39095.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26484.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31507.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25222.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40861.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25222.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":30267.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":25704.63},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22189.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24693.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30675.83},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25222.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29006.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19781.61},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31679.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25979.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":24620.94},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","code_information":[{"code":"626","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10413.48,"maximum":22772.32,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19723.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13360.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16586.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12724.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20613.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12724.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15269.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13531.49},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11681.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12457.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16148.44},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12724.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14633.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10413.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16676.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13106.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12961.01},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","code_information":[{"code":"627","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8740.92,"maximum":19114.75,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17543.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11884.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13922.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11318.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18335.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11318.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13582.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11358.13},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9805.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11080.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13554.76},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11318.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13016.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8740.92},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13998.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11657.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10879.28},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10048.47,"maximum":21974.11,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18924.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12819.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16004.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12209.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19779.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12209.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":14651.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13057.19},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11271.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11952.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15582.41},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12209.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14040.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10048.47},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16092.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12575.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12506.7},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12331.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12209.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":18732.39},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20539.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12209.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21974.11},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12209.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12819.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18313.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12575.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21395.96},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":12209.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12331.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12209.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":13755.58,"10th_percentile":13755.58,"90th_percentile":13755.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6328.68,"maximum":13839.63,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8155.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10080.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7767.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12582.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7767.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9320.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8223.62},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7099.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7603.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9814.04},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7767.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8932.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6328.68},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10135.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8000.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7876.91},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7844.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7767.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11797.94},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12936.19},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7767.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13839.63},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7767.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8155.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11650.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8000.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13475.5},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7767.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7844.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7767.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7284.09,"10th_percentile":7284.09,"90th_percentile":7284.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7272.73,"10th_percentile":7272.73,"90th_percentile":7272.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6610.2,"10th_percentile":6610.2,"90th_percentile":6610.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4323.54,"maximum":9454.77,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8535.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5782.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6886.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5506.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8921.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5506.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":6608.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":5618.1},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":4849.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5391.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6704.62},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5506.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6332.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4323.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6923.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5672.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5381.24},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9163.89,"maximum":20039.7,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17636.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11947.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14595.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11378.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18432.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11378.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13654.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11907.74},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10279.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11139.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14210.67},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11378.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13085.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9163.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14675.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11719.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11405.72},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11492.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11378.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":17083.35},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18731.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11378.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20039.7},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11378.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11947.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17067.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11719.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19512.45},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":11378.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11492.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11378.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4935.1,"10th_percentile":4935.1,"90th_percentile":4935.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8936.58,"10th_percentile":8936.58,"90th_percentile":8936.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5392.35,"maximum":11792.05,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10535.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7137.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8588.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11011.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8156.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7006.93},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6048.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6654.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8362.05},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7816.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5392.35},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8635.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7001.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6711.52},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6865.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":10052.43},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11022.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11792.05},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7137.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10195.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7001.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11481.8},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6797.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6865.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6374.75,"10th_percentile":6374.75,"90th_percentile":6374.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8563.59,"maximum":19584.68,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18738.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12693.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13639.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12089.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19584.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12089.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":14507.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11127.7},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9606.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11835.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13279.77},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12089.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13902.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8563.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13714.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12451.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10658.57},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12210.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12089.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":15964.27},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17504.47},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12089.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18726.96},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12089.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12693.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18133.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12451.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18234.24},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":12089.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12210.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12089.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Mcc","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11435.37,"maximum":25007.0,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21592.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14626.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18213.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13930.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22567.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13930.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":16716.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14859.35},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12827.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13637.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17733.11},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13930.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16019.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11435.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18313.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14348.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14232.89},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14069.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13930.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":21317.85},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23374.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13930.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25007.0},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13930.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14626.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20895.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14348.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24349.05},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":13930.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14069.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13930.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5974.96,"10th_percentile":5974.96,"90th_percentile":5974.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"1 through 10","median_amount":15258.0,"10th_percentile":15258.0,"90th_percentile":15258.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7131.15,"maximum":15594.48,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13679.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9266.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11358.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8825.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14297.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8825.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10590.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9266.36},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7999.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8640.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11058.45},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8825.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10149.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7131.15},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11420.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9090.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8875.7},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8913.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8825.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":13293.91},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14576.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8825.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15594.48},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8825.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9266.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13238.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9090.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15184.18},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8825.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8913.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8825.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8261.43,"10th_percentile":8261.43,"90th_percentile":8261.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5375.1,"maximum":11754.33,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10409.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7051.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8561.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6715.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10879.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6715.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8059.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6984.51},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6029.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6574.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8335.3},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6715.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7723.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5375.1},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8607.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6917.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6690.05},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis With Mcc","code_information":[{"code":"650","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31788.3,"maximum":69515.02,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60513.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40993.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50630.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39041.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63246.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39041.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":46849.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":41306.36},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":35658.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38221.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49294.9},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39041.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44897.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31788.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50907.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40212.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":39564.92},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis Without Mcc","code_information":[{"code":"651","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23958.18,"maximum":52392.03,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47830.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32401.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38159.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30858.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49990.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30858.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":37030.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":31131.75},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26874.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30210.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37152.54},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30858.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35487.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23958.18},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38367.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31784.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":29819.25},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant","code_information":[{"code":"652","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21191.28,"maximum":46341.34,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41763.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28291.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33752.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26943.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43649.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26943.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":32332.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":27536.38},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23771.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26378.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32861.84},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26943.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30985.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21191.28},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33936.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27752.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":26375.47},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27213.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26943.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":39504.85},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":43316.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26943.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46341.34},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26943.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28291.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40415.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27752.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45122.07},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":26943.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27213.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26943.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Mcc","code_information":[{"code":"653","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38461.98,"maximum":84109.1,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66819.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45264.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61260.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43109.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69837.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43109.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":51731.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":49978.28},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":43144.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42204.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":59643.94},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43109.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49575.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38461.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61594.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44402.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":47871.23},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43540.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43109.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":71700.93},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":78618.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43109.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":84109.1},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43109.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45264.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64664.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44402.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":81896.15},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":43109.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43540.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43109.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures With Cc/Mcc","code_information":[{"code":"113","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15570.54,"maximum":34049.84,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30573.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20710.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24800.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19724.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31953.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19724.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":23669.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":20232.68},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17466.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19310.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24145.62},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19724.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22683.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15570.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24935.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20316.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":19379.68},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19921.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19724.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":29026.65},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31827.09},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19724.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34049.84},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19724.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20710.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29586.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20316.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33153.97},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":19724.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19921.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19724.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5866.38,"maximum":12828.67,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11275.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7638.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9343.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7274.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11785.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7274.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8729.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7622.89},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6580.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7121.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9097.14},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7274.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8365.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5866.38},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9394.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7493.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7301.52},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7347.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7274.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":10936.12},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11991.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7274.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12828.67},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7274.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7638.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10912.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7493.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12491.14},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7274.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7347.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7274.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4423.85,"10th_percentile":4423.85,"90th_percentile":4423.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7999.86,"maximum":17494.19,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14901.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10094.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12741.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9613.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15574.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9613.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11536.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":10395.18},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8973.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9411.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12405.58},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9613.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11055.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7999.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12811.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9902.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9956.93},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9709.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9613.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":14913.36},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16352.18},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9613.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17494.19},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9613.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10094.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14420.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9902.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17033.9},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":9613.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9709.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9613.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"1 through 10","median_amount":12318.69,"10th_percentile":12318.69,"90th_percentile":12318.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6359.04,"maximum":13906.02,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12120.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8210.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10128.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7819.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12667.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7819.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9383.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8263.07},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7133.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7655.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9861.12},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7819.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8992.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6359.04},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10183.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8054.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7914.7},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7897.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7819.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11854.54},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12998.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7819.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13906.02},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7819.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8210.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11729.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8054.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13540.15},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7819.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7897.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7819.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13697.88,"maximum":29954.68,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25295.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17135.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21817.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16319.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26437.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16319.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":19583.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":17799.3},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15365.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15976.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21241.64},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16319.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18767.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13697.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21936.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16809.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":17048.9},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16482.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16319.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":25535.63},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27999.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16319.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29954.68},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16319.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17135.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24479.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16809.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29166.56},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":16319.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16482.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16319.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10778.19,"10th_percentile":10778.19,"90th_percentile":10778.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"1 through 10","median_amount":36156.14,"10th_percentile":36156.14,"90th_percentile":36156.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9613.08,"maximum":21021.99,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17977.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12178.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15311.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11598.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18789.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11598.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13918.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":12491.43},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10783.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11355.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14907.24},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11598.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13338.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9613.08},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15394.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11946.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11964.8},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11714.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11598.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":17920.73},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19649.69},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11598.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21021.99},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11598.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12178.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17397.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11946.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20468.89},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":11598.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11714.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11598.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14966.79,"maximum":32729.55,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29857.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20225.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23838.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19262.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31205.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19262.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":23115.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":19448.15},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16788.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18858.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23209.37},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19262.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22152.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14966.79},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23968.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19840.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":18628.23},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19455.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19262.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":27901.13},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30592.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19262.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32729.55},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19262.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20225.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28893.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19840.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31868.42},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":19262.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19455.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19262.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24735.12,"maximum":54091.05,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46633.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31590.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39396.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30085.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48739.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30085.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":36103.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":32141.32},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27746.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29454.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38357.36},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30085.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34598.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24735.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39612.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30988.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":30786.26},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30386.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30085.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":46111.28},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":50560.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30085.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54091.05},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30085.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31590.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45128.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30988.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52667.88},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":30085.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30386.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30085.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16539.3,"maximum":36168.33,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33478.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22679.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26343.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21599.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34990.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21599.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":25919.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":21491.5},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18552.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21145.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25647.9},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21599.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24839.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16539.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26486.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22247.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":20585.44},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21815.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21599.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":30832.61},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":33807.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21599.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36168.33},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21599.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22679.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32398.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22247.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35216.72},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":21599.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21815.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21599.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16539.3,"maximum":36168.33,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33478.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22679.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26343.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21599.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34990.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21599.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":25919.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":21491.5},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18552.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21145.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25647.9},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21599.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24839.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16539.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26486.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22247.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":20585.44},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21815.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21599.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":30832.61},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":33807.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21599.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36168.33},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21599.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22679.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32398.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22247.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35216.72},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":21599.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21815.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21599.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25173.96,"maximum":55050.71,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45456.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30792.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40095.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29326.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47508.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29326.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":35191.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":32711.55},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28238.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28710.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39037.88},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29326.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33725.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25173.96},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40314.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30206.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":31332.46},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29619.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29326.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":46929.37},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":51457.03},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29326.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":55050.71},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29326.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30792.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43989.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30206.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53602.29},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":29326.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29619.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29326.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5446.17,"maximum":11909.75,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10766.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7293.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8674.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6946.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11252.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6946.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8335.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7076.86},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6109.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6800.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8445.51},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6946.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7987.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5446.17},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8721.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7154.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6778.51},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7015.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6946.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":10152.77},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11132.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6946.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11909.75},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6946.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7293.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10419.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7154.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11596.4},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6946.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7015.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6946.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5160.53,"10th_percentile":5160.53,"90th_percentile":5160.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7305.72,"maximum":15976.23,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13654.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9249.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11636.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8809.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14270.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8809.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10571.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9493.2},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8195.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8624.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11329.16},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8809.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10130.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7305.72},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11699.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9073.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9092.97},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8897.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8809.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":13619.34},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14933.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8809.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15976.23},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8809.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9249.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13213.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9073.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15555.89},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8809.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8897.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8809.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12577.32,"maximum":27504.23,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22994.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15576.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20032.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14835.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24033.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14835.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":17802.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":16343.22},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14108.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14523.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19503.96},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14835.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17060.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12577.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20141.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15280.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15654.21},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14983.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14835.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":23446.68},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25708.77},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14835.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27504.23},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14835.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15576.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22252.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15280.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26780.58},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":14835.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14983.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14835.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6520.41,"10th_percentile":6520.41,"90th_percentile":6520.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5914.68,"maximum":12934.29,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11109.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7525.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9420.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7167.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11610.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7167.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8600.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7685.66},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6634.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7016.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9172.04},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7167.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8242.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5914.68},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9472.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7382.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7361.63},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7238.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7167.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11026.16},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12089.95},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7167.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12934.29},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7167.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7525.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10750.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7382.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12593.98},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7167.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7238.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7167.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Cc","code_information":[{"code":"654","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19471.11,"maximum":42579.65,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36282.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24578.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31012.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23408.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37921.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23408.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":28089.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":25301.16},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21841.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22916.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30194.33},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23408.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26919.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19471.11},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31182.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24110.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":24234.48},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures Without Cc/Mcc","code_information":[{"code":"655","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14332.68,"maximum":31342.87,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27585.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18687.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22828.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17797.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28831.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17797.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":21356.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":18624.18},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16077.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17423.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22226.04},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17797.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20466.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14332.68},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22953.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18331.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":17838.99},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Mcc","code_information":[{"code":"656","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22478.13,"maximum":49155.44,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41180.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27896.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35802.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26568.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43040.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26568.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":31881.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":29208.54},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25214.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26010.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34857.39},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26568.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30553.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22478.13},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35997.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27365.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":27977.13},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Cc","code_information":[{"code":"657","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12613.2,"maximum":27582.69,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23934.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16213.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20089.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15441.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25015.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15441.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18530.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":16389.85},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14148.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15117.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19559.6},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15441.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17758.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12613.2},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20199.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15905.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15698.86},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","code_information":[{"code":"658","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10376.91,"maximum":22692.35,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20390.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13813.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16527.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13155.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21311.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13155.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15786.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13483.97},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11640.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12879.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16091.73},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13155.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15128.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10376.91},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16618.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13549.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12915.49},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","code_information":[{"code":"659","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17830.98,"maximum":38992.99,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32990.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22348.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28400.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21284.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34480.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21284.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":25541.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":23169.94},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20001.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20837.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27650.94},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21284.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24477.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17830.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28555.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21923.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":22193.11},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21497.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21284.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":33240.56},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":36447.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21284.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38992.99},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21284.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22348.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31926.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21923.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37967.07},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":21284.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21497.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21284.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Cc","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9245.31,"maximum":20217.75,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17459.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11827.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14725.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11264.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18247.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11264.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13516.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":12013.54},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10370.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11027.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14336.93},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11264.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12953.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9245.31},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14805.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11602.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11507.06},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11376.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11264.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":17235.13},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18897.95},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11264.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20217.75},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11264.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11827.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16896.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11602.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19685.81},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":11264.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11376.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11264.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":34998.94,"10th_percentile":34998.94,"90th_percentile":34998.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","code_information":[{"code":"661","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7083.54,"maximum":15490.37,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13812.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9356.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11282.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8911.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14436.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8911.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10693.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9204.5},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7945.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8723.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10984.62},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8911.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10247.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7083.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11343.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9178.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8816.44},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9000.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8911.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":13205.16},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14479.17},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8911.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15490.37},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8911.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9356.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13366.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9178.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15082.81},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8911.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9000.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8911.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5528.46,"10th_percentile":5528.46,"90th_percentile":5528.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Mcc","code_information":[{"code":"662","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21523.86,"maximum":47068.63,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39622.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26841.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34282.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25563.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41412.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25563.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":30675.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":27968.54},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24144.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25026.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33377.58},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25563.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29397.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21523.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34469.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26330.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":26789.41},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25818.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25563.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":40124.84},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":43996.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25563.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47068.63},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25563.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26841.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38344.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26330.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45830.22},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":25563.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25818.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25563.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Cc","code_information":[{"code":"663","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10538.37,"maximum":23045.43,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19988.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13540.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16785.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12895.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20890.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12895.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15474.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13693.77},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11821.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12624.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16342.11},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12895.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14829.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10538.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16876.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13282.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13116.45},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13024.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12895.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":19645.66},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21541.04},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12895.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23045.43},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12895.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13540.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19343.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13282.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22439.09},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":12895.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13024.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12895.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures Without Cc/Mcc","code_information":[{"code":"664","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7450.62,"maximum":16293.1,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13958.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9455.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11867.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9005.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14589.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9005.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10806.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9681.49},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8357.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8816.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11553.86},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9005.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10356.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7450.62},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11931.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9275.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9273.32},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Mcc","code_information":[{"code":"665","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23690.46,"maximum":51806.57,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40383.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27356.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37733.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26053.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42207.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26053.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":31264.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":30783.86},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26574.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25506.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36737.38},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26053.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29961.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23690.46},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37939.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26835.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":29486.04},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Cc","code_information":[{"code":"666","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11365.68,"maximum":24854.6,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22906.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15517.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18102.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14778.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23941.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14778.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":17734.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14768.8},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12749.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14468.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17625.04},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14778.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16995.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11365.68},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18201.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15221.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14146.15},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy Without Cc/Mcc","code_information":[{"code":"667","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7091.13,"maximum":15506.97,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14714.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9967.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11294.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9493.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15378.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9493.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11391.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9214.36},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7954.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9293.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10996.39},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9493.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10916.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7091.13},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11356.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9777.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8825.89},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Mcc","code_information":[{"code":"668","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20121.09,"maximum":44001.03,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37820.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25620.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32047.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24400.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39528.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24400.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":29280.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":26145.75},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22570.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23887.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31202.27},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24400.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28060.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20121.09},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32222.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25132.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":25043.47},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Cc","code_information":[{"code":"669","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10677.75,"maximum":23350.23,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20393.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13814.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17007.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13156.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21314.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13156.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15788.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13874.89},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11977.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12880.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16558.25},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13156.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15130.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10677.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17099.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13551.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13289.93},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13288.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13156.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":19905.49},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21825.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13156.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23350.23},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13156.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13814.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19735.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13551.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22735.87},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":13156.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13288.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13156.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures Without Cc/Mcc","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6593.64,"maximum":14419.05,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13072.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8855.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10502.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8433.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13662.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8433.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10120.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8567.91},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7396.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8256.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10224.92},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8433.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9698.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6593.64},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10559.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8686.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8206.69},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures With Cc/Mcc","code_information":[{"code":"671","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11892.84,"maximum":26007.4,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23488.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15911.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18942.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15154.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24549.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15154.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18184.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15453.8},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13340.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14835.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18442.52},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15154.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17427.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11892.84},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19045.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15608.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14802.28},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures Without Cc/Mcc","code_information":[{"code":"672","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7550.67,"maximum":16511.89,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14374.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9737.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12026.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9273.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15023.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9273.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11128.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9811.49},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8469.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9078.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11709.01},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9273.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10664.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7550.67},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12092.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9551.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9397.85},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9366.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9273.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":14075.98},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15434.01},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9273.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16511.89},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9273.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9737.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13910.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9551.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16077.46},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":9273.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9366.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9273.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Mcc","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28911.0,"maximum":63222.91,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54146.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36680.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46048.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34933.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56592.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34933.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":41920.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":37567.54},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":32430.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34199.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44833.0},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34933.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40173.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28911.0},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46299.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35981.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":35983.72},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35282.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34933.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":53895.97},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":59095.76},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34933.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":63222.91},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34933.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36680.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52400.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35981.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":61559.48},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":34933.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35282.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34933.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":49206.74,"10th_percentile":49206.74,"90th_percentile":49206.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Cc","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15927.27,"maximum":34829.94,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30413.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20602.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25368.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19621.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31787.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19621.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":23546.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":20696.22},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17866.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19209.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24698.81},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19621.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22565.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15927.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25506.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20210.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":19823.68},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19818.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19621.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":29691.66},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":32556.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19621.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34829.94},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19621.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20602.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29432.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20210.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33913.54},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":19621.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19818.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19621.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"1 through 10","median_amount":14880.0,"10th_percentile":14880.0,"90th_percentile":14880.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","code_information":[{"code":"675","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10799.88,"maximum":23617.3,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21532.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14586.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17201.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13891.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22504.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13891.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":16670.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14033.58},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12114.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13599.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16747.64},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13891.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15975.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10799.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17295.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14308.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13441.94},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14030.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13891.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":20133.17},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22075.58},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13891.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23617.3},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13891.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14586.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20837.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14308.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22995.92},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":13891.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14030.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13891.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10363.8,"maximum":22663.68,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19488.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13202.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16506.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12573.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20368.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12573.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15088.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13466.93},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11625.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12309.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16071.4},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12573.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14459.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10363.8},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16597.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12950.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12899.18},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12699.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12573.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":19320.23},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21184.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12573.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22663.68},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12573.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13202.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18860.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12950.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22067.38},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":12573.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12699.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12573.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12001.79,"10th_percentile":12001.79,"90th_percentile":12001.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11789.05,"10th_percentile":11789.05,"90th_percentile":11789.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6133.41,"maximum":13412.61,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11779.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7979.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9769.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7599.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12311.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7599.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9119.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7969.88},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6880.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7439.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9511.23},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7599.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8739.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6133.41},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9822.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7827.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7633.87},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7675.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7599.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11433.92},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12537.05},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7599.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13412.61},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7599.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7979.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11399.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7827.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13059.72},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7599.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7675.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7599.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7116.15,"10th_percentile":7116.15,"90th_percentile":7116.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4191.75,"maximum":9166.57,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8269.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5601.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6676.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5335.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8642.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5335.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":6402.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":5446.85},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":4702.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6500.25},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5335.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6135.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4191.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6712.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5495.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5217.21},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5388.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5335.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":7814.27},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8568.18},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5335.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9166.57},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5335.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5601.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8002.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5495.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8925.39},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":5335.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5388.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5335.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Mcc","code_information":[{"code":"686","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13010.64,"maximum":28451.82,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23599.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15986.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20722.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15225.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24665.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15225.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18270.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":16906.29},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14594.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14905.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20175.92},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15225.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17509.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13010.64},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20835.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15682.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":16193.53},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15377.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15225.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":24254.47},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26594.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15225.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28451.82},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15225.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15986.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22838.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15682.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27703.24},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":15225.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15377.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15225.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Cc","code_information":[{"code":"687","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7262.94,"maximum":15882.68,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13970.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9463.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11568.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9013.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14601.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9013.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10815.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9437.61},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8147.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8823.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11262.82},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9013.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10364.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7262.94},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11631.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9283.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9039.73},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9103.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9013.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":13539.59},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14845.87},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9013.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15882.68},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9013.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9463.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13519.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9283.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15464.8},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":9013.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9103.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9013.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","code_information":[{"code":"688","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4996.98,"maximum":11172.65,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10689.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7241.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7958.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6896.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11172.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6896.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8276.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6493.18},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5605.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6751.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7748.94},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6896.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7931.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4996.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8002.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7103.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6219.43},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6965.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6896.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":9315.38},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10214.12},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6896.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10927.45},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6896.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7241.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10345.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7103.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10639.95},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6896.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6965.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6896.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8075.76,"maximum":17660.17,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15403.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10434.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12862.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9937.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16098.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9937.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11925.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":10493.81},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9058.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9728.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12523.28},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9937.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11428.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8075.76},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12932.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10235.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10051.4},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10037.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9937.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":15054.86},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16507.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9937.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17660.17},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9937.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10434.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14906.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10235.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17195.52},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":9937.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10037.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9937.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9300.0,"10th_percentile":9300.0,"90th_percentile":9300.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":18798.27,"10th_percentile":18798.27,"90th_percentile":18798.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5537.94,"maximum":12110.43,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10934.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7407.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8820.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7054.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11428.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7054.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8465.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7196.11},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6212.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6906.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8587.82},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7054.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8112.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5537.94},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8868.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7266.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6892.73},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7125.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7054.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":10323.84},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11319.87},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7054.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12110.43},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7054.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7407.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10581.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7266.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11791.8},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7054.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7125.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7054.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":22356.53,"10th_percentile":22356.53,"90th_percentile":22356.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones With Mcc","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10145.07,"maximum":22185.36,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17749.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12024.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16158.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11451.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18551.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11451.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13741.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13182.71},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11380.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11211.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15732.21},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11451.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13169.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10145.07},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16246.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11795.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12626.94},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11566.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11451.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":18912.47},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20737.11},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11451.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22185.36},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11451.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12024.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17177.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11795.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21601.65},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":11451.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11566.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11451.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5391.66,"maximum":11790.54,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10580.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7167.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8587.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6826.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11058.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6826.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8191.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7006.03},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6048.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6682.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8360.98},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6826.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7849.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5391.66},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8634.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7030.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6710.66},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6894.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6826.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":10051.15},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11020.87},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6826.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11790.54},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6826.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7167.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10239.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7030.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11480.33},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6826.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6894.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6826.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms With Mcc","code_information":[{"code":"695","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7781.13,"maximum":17015.87,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15193.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10292.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12393.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9802.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15879.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9802.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11762.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":10110.96},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8728.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9596.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12066.39},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9802.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11272.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7781.13},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12461.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10096.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9684.69},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9900.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9802.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":14505.61},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15905.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9802.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17015.87},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9802.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10292.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14703.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10096.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16568.17},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":9802.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9900.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9802.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms Without Mcc","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4772.73,"maximum":10437.06,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9399.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6367.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7601.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6064.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9823.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6064.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7276.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6201.78},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5353.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5936.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7401.19},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6064.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6973.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4772.73},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7643.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6246.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5940.32},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6124.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6064.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":8897.34},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9755.74},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6064.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10437.06},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6064.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6367.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9096.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6246.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10162.46},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6064.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6124.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6064.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Stricture","code_information":[{"code":"697","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6912.42,"maximum":15116.16,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14352.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9722.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11009.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9259.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15000.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9259.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11111.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8982.14},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7753.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9065.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10719.26},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9259.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10648.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6912.42},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11069.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9537.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8603.46},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9352.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9259.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":12886.15},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14129.39},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9259.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15116.16},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9259.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9722.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13889.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9537.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14718.45},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":9259.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9352.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9259.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11598.21,"maximum":25363.1,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21697.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14698.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18473.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13998.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22677.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13998.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":16798.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15070.95},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13010.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13704.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17985.63},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13998.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16098.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11598.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18573.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14418.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14435.57},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14138.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13998.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":21621.42},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23707.41},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13998.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25363.1},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13998.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14698.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20997.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14418.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24695.78},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":13998.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14138.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13998.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9664.61,"10th_percentile":9664.61,"90th_percentile":9664.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13260.91,"10th_percentile":13260.91,"90th_percentile":13260.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"750","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8897.55,"maximum":20299.67,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19422.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13157.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14171.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12530.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20299.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12530.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15036.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11561.66},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9980.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12267.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13797.65},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12530.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14410.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8897.55},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14248.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12906.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11074.23},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12655.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12530.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":16586.84},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18187.11},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12530.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19457.27},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12530.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13157.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18795.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12906.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18945.33},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":12530.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12655.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12530.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Mcc","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12483.48,"maximum":27299.02,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24083.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16314.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19883.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15537.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25171.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15537.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18645.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":16221.29},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14003.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15211.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19358.44},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15537.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17868.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12483.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19991.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16004.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15537.41},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15693.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15537.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":23271.74},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25516.96},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15537.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27299.02},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15537.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16314.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23306.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16004.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26580.77},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":15537.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15693.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15537.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":32465.47,"10th_percentile":32465.47,"90th_percentile":32465.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Cc","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7659.69,"maximum":16750.3,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14479.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9808.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12200.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9341.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15133.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9341.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11210.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9953.16},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8592.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9145.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11878.07},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9341.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10743.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7659.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12266.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9622.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9533.54},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9435.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9341.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":14279.22},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15656.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9341.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16750.3},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9341.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9808.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14012.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9622.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16309.59},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":9341.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9435.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9341.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"756","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6588.81,"maximum":14408.49,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12858.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8710.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10494.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8295.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13438.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8295.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9954.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8561.63},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7390.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8121.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10217.43},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8295.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9539.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6588.81},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10551.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8544.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8200.68},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8378.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8295.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":12282.88},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13467.91},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8295.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14408.49},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8295.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8710.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12443.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8544.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14029.39},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8295.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8378.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8295.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Mcc","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9764.88,"maximum":21353.95,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18863.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12778.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15553.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12169.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19715.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12169.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":14603.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":12688.68},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10953.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11914.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15142.64},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12169.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13995.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9764.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15637.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12534.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12153.74},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Cc","code_information":[{"code":"758","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7033.17,"maximum":15380.22,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13093.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8869.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11202.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8447.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13685.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8447.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10137.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9139.04},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7889.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8270.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10906.51},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8447.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9714.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7033.17},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11263.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8701.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8753.75},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4415.31,"maximum":9655.45,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9075.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6148.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7032.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5855.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9485.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5855.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7026.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":5737.34},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":4952.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5732.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6846.93},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5855.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6733.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4415.31},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7070.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6031.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5495.46},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5913.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5855.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":8231.03},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9025.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5855.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9655.45},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5855.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6148.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8783.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6031.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9401.41},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":5855.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5913.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5855.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6799.95,"maximum":14870.21,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13456.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9115.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10830.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8681.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14064.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8681.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10418.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8835.99},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7627.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8499.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10544.85},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8681.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9984.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6799.95},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10889.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8942.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8463.47},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8768.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8681.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":12676.49},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13899.49},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8681.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14870.21},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8681.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9115.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13022.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8942.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14478.97},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8681.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8768.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8681.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4373.91,"maximum":9564.92,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7889.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5344.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6966.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5090.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8246.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5090.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":6108.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":5683.55},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":4906.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4983.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6782.73},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5090.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5853.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4373.91},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7004.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5242.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5443.93},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7564.47,"maximum":16542.07,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14273.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9669.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12048.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9208.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14918.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9208.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11050.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9829.43},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8485.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9015.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11730.41},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9208.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10589.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7564.47},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12114.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9484.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9415.02},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9300.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9208.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":14101.71},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15462.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9208.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16542.07},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9208.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9669.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13812.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9484.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16106.84},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":9208.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9300.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9208.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"1 through 10","median_amount":17636.07,"10th_percentile":17636.07,"90th_percentile":17636.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"1 through 10","median_amount":14384.11,"10th_percentile":14384.11,"90th_percentile":14384.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6401.76,"10th_percentile":6401.76,"90th_percentile":6401.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":16402.37,"10th_percentile":13699.28,"90th_percentile":72221.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"1 through 10","median_amount":9143.0,"10th_percentile":9143.0,"90th_percentile":9143.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Postpartum And Post Abortion Diagnoses With O.R. Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9587.55,"maximum":23148.96,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22148.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15003.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15270.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14289.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23148.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14289.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":17147.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":12458.26},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10754.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13989.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14867.65},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14289.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16432.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9587.55},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15353.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14718.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11933.03},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14432.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14289.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":17873.14},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19597.51},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14289.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20966.17},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14289.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15003.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21434.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14718.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20414.53},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":14289.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14432.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14289.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":3338.74,"10th_percentile":3338.74,"90th_percentile":35038.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7423.71,"maximum":16234.26,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13395.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9074.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11824.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8642.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14000.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8642.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10370.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9646.52},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8327.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8460.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11512.13},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8642.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9938.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7423.71},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11888.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8901.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9239.83},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8728.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8642.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":13839.3},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15174.49},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8642.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16234.26},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8642.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9074.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12963.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8901.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15807.12},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8642.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8728.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8642.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4922.46,"maximum":10764.49,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8962.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6071.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7840.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5782.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9367.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5782.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":6938.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6396.34},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5521.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5660.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7633.38},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5782.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6649.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4922.46},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7883.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5955.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6126.68},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"1 through 10","median_amount":6096.09,"10th_percentile":6096.09,"90th_percentile":6096.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":8738.11,"10th_percentile":8738.11,"90th_percentile":9453.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3578.9,"10th_percentile":3578.9,"90th_percentile":3578.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion Without D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6449.43,"maximum":14103.69,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11339.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7681.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10272.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7315.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11851.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7315.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8779.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8380.52},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7234.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7162.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10001.29},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7315.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8413.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6449.43},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10328.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7535.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8027.2},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"1 through 10","median_amount":7648.1,"10th_percentile":7648.1,"90th_percentile":7648.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2724.84,"10th_percentile":2724.84,"90th_percentile":2724.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":9550.37,"10th_percentile":9550.37,"90th_percentile":9550.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Mcc","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12709.8,"maximum":33338.47,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31897.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21608.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20243.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20579.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33338.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20579.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":24695.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":16515.37},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14257.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20147.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19709.4},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20579.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23666.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12709.8},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20354.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21196.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15819.1},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Cc","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7472.7,"maximum":16341.39,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14126.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9569.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11902.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9114.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14764.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9114.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10936.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9710.18},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8382.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8922.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11588.1},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9114.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10481.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7472.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11967.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9387.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9300.8},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization Without Cc/Mcc","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6036.81,"maximum":13402.81,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12823.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8687.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9615.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8273.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13402.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8273.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9928.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7844.35},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6771.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8099.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9361.43},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8273.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9514.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6036.81},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9667.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8521.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7513.64},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8356.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8273.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11253.84},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12339.59},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8273.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13201.37},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8273.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8687.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12410.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8521.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12854.03},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8273.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8356.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8273.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"1 through 10","median_amount":10526.22,"10th_percentile":10526.22,"90th_percentile":10526.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":27142.59,"10th_percentile":27142.59,"90th_percentile":27142.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11149.02,"maximum":24380.81,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21635.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14656.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17757.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13958.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22612.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13958.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":16749.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14487.26},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12506.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13665.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17289.06},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13958.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16052.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11149.02},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17854.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14377.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13876.49},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14097.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13958.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":20784.04},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22789.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13958.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24380.81},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13958.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14656.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20937.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14377.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23739.33},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":13958.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14097.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13958.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"1 through 10","median_amount":15976.48,"10th_percentile":15976.48,"90th_percentile":15976.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":30921.07,"10th_percentile":30921.07,"90th_percentile":30921.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8623.41,"10th_percentile":8623.41,"90th_percentile":8623.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"1 through 10","median_amount":9744.0,"10th_percentile":9744.0,"90th_percentile":9744.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7326.42,"maximum":16021.5,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14849.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10059.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11669.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9580.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15519.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9580.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11496.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9520.1},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8218.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9378.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11361.26},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9580.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11017.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7326.42},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11732.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9867.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9118.74},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"1 through 10","median_amount":25196.27,"10th_percentile":25196.27,"90th_percentile":51013.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6918.82,"10th_percentile":6918.82,"90th_percentile":6918.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":33280.24,"10th_percentile":21110.66,"90th_percentile":44728.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5362.12,"10th_percentile":5362.12,"90th_percentile":5362.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6244.5,"maximum":13655.55,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12836.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8695.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9945.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8281.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13416.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8281.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9937.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8114.23},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7004.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8107.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9683.5},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8281.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9523.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6244.5},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10000.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8530.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7772.14},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"1 through 10","median_amount":17429.33,"10th_percentile":17429.33,"90th_percentile":19219.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6918.82,"10th_percentile":5362.12,"90th_percentile":6918.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"13","median_amount":22280.83,"10th_percentile":19861.02,"90th_percentile":37679.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"1 through 10","median_amount":8475.79,"10th_percentile":8475.79,"90th_percentile":8475.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5362.12,"10th_percentile":5362.12,"90th_percentile":6918.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5630.23,"10th_percentile":5630.23,"90th_percentile":7264.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"1 through 10","median_amount":9744.0,"10th_percentile":9744.0,"90th_percentile":9744.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12438.63,"maximum":27200.94,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23580.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15973.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19811.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15213.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24645.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15213.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18255.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":16163.01},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13952.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14893.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19288.89},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15213.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17495.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12438.63},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19919.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15669.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15481.59},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15365.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15213.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":23188.13},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25425.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15213.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27200.94},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15213.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15973.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22819.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15669.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26485.27},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":15213.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15365.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15213.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":33815.3,"10th_percentile":33815.3,"90th_percentile":33815.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41020.5,"maximum":89704.11,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76336.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51712.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65335.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49249.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":79784.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49249.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":59099.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":53302.87},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":46014.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48215.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":63611.5},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49249.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56637.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41020.5},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65692.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50727.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":51055.66},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49742.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49249.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":76470.54},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":83848.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49249.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":89704.11},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49249.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51712.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":73874.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50727.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":87343.94},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":49249.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49742.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49249.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":13032.08,"10th_percentile":13032.08,"90th_percentile":13032.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity With Major Problems","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28014.69,"maximum":61262.85,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52330.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35449.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44620.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33761.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54693.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33761.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":40513.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":36402.86},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31425.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33052.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43443.07},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33761.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38825.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28014.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44864.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34774.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":34868.14},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34098.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33761.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":52225.07},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":57263.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33761.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":61262.85},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33761.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35449.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50642.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34774.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":59650.99},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":33761.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34098.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33761.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":20633.4,"10th_percentile":20633.4,"90th_percentile":20633.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16903.62,"maximum":36965.03,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31822.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21557.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26923.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20530.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33259.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20530.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":24636.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":21964.91},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18961.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20099.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26212.86},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20530.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23610.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16903.62},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27070.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21146.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":21038.88},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20736.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20530.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":31511.78},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":34551.98},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20530.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36965.03},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20530.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21557.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30796.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21146.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35992.46},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":20530.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20736.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20530.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1372.71,"10th_percentile":1372.71,"90th_percentile":1372.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28777.14,"maximum":62930.18,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53739.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36403.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45834.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34670.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56166.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34670.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":41604.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":37393.6},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":32280.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33942.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44625.42},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34670.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39870.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28777.14},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46085.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35710.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":35817.11},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35017.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34670.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":53646.43},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":58822.14},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34670.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":62930.18},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34670.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36403.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52005.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35710.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":61274.46},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":34670.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35017.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34670.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2446.16,"10th_percentile":1372.71,"90th_percentile":4490.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10185.78,"maximum":22274.38,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19423.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13158.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16223.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12531.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20301.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12531.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15037.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13235.61},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11425.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12268.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15795.34},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12531.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14411.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10185.78},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16312.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12907.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12677.61},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12656.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12531.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":18988.36},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20820.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12531.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22274.38},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12531.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13158.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18797.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12907.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21688.33},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":12531.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12656.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12531.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1008.77,"10th_percentile":1008.77,"90th_percentile":1008.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"25","median_amount":979.37,"10th_percentile":979.37,"90th_percentile":1372.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"1 through 10","median_amount":3744.87,"10th_percentile":3744.87,"90th_percentile":3744.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1372.71,"10th_percentile":979.37,"90th_percentile":1739.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1028.34,"10th_percentile":1028.34,"90th_percentile":1028.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"1 through 10","median_amount":7664.0,"10th_percentile":7664.0,"90th_percentile":7664.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":1378.62,"maximum":3310.50,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3167.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2145.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2195.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2043.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3310.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2043.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":2452.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":1791.41},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":1546.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2000.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":2137.86},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2043.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":2350.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1378.62},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2207.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2104.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":1715.88},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2043.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":2570.03},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":2817.98},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2043.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":3014.78},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2043.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2145.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3065.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2104.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":2935.46},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":2043.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2063.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2043.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1008.77,"10th_percentile":1008.77,"90th_percentile":1008.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"16","median_amount":979.37,"10th_percentile":979.37,"90th_percentile":979.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":2156.77,"10th_percentile":2156.77,"90th_percentile":2156.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"1 through 10","median_amount":1766.23,"10th_percentile":1766.23,"90th_percentile":1766.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":979.37,"10th_percentile":979.37,"90th_percentile":979.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1028.34,"10th_percentile":1028.34,"90th_percentile":1028.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Mcc","code_information":[{"code":"796","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8808.54,"maximum":19262.62,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15488.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10492.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14029.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9992.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16188.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9992.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11991.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11446.0},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9880.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9782.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13659.62},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9992.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11491.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8808.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14106.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10292.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10963.44},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10092.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9992.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":16420.91},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18005.17},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9992.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19262.62},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9992.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10492.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14989.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10292.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18755.81},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":9992.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10092.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9992.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Cc","code_information":[{"code":"797","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6680.58,"maximum":14609.17,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13366.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9054.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10640.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8623.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13970.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8623.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10348.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8680.88},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7493.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8442.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10359.74},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8623.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9916.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6680.58},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10698.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8882.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8314.9},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6680.58,"maximum":14609.17,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12814.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8680.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10640.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8267.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13393.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8267.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9921.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8680.88},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7493.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8093.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10359.74},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8267.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9507.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6680.58},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10698.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8515.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8314.9},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8350.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8267.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":12453.96},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13655.49},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8267.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14609.17},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8267.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8680.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12401.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8515.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14224.79},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8267.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8350.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8267.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Mcc","code_information":[{"code":"799","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32806.05,"maximum":71740.65,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58316.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39504.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52251.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37623.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60949.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37623.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":45148.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":42628.85},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":36799.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36833.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50873.15},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37623.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43266.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32806.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52537.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38752.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":40831.65},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37999.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37623.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":61157.13},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":67057.47},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37623.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":71740.65},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37623.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39504.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56435.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38752.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":69853.11},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":37623.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37999.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37623.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Cc","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20103.84,"maximum":43963.31,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36411.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24665.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32020.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23491.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38055.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23491.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":28189.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":26123.34},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22551.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22997.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31175.52},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23491.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27014.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20103.84},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32195.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24195.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":25022.0},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23726.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23491.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":37477.64},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":41093.41},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23491.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43963.31},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23491.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24665.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35236.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24195.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42806.61},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":23491.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23726.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23491.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures Without Cc/Mcc","code_information":[{"code":"801","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11327.73,"maximum":26066.14,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24939.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16894.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18042.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16090.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26066.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16090.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":19308.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14719.48},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12706.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15752.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17566.19},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16090.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18503.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11327.73},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18140.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16572.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14098.92},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","code_information":[{"code":"802","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24733.74,"maximum":54088.03,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51375.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34803.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39394.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33145.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53696.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33145.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":39774.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":32139.52},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27744.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32449.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38355.22},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33145.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38117.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24733.74},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39609.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34140.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":30784.54},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","code_information":[{"code":"803","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12281.31,"maximum":26856.91,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24302.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16463.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19561.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15679.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25400.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15679.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18815.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15958.58},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13776.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15350.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19044.93},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15679.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18031.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12281.31},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19667.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16149.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15285.78},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","code_information":[{"code":"804","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7627.95,"maximum":18704.60,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17896.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12123.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12149.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11546.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18704.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11546.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13855.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9911.91},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8556.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11303.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11828.85},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11546.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13277.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7627.95},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12215.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11892.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9494.03},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Mcc","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6885.51,"maximum":15057.31,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14370.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9734.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10966.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9271.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15019.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9271.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11125.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8947.17},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7723.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9076.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10677.53},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9271.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10661.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6885.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11026.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9549.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8569.97},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"1 through 10","median_amount":7409.46,"10th_percentile":7409.46,"90th_percentile":7409.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3832.16,"10th_percentile":3832.16,"90th_percentile":3832.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":44786.73,"10th_percentile":44786.73,"90th_percentile":44786.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4992.15,"maximum":10916.89,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10227.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6928.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7951.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6598.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10689.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6598.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7918.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6486.9},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5599.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6459.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7741.45},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6598.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7588.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4992.15},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7994.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6796.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6213.42},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3947.14,"10th_percentile":3947.14,"90th_percentile":3947.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"1 through 10","median_amount":11008.38,"10th_percentile":11008.38,"90th_percentile":11008.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"1 through 10","median_amount":20805.96,"10th_percentile":20805.96,"90th_percentile":20805.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3832.16,"10th_percentile":3832.16,"90th_percentile":3832.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"11","median_amount":11525.28,"10th_percentile":8812.73,"90th_percentile":18860.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"1 through 10","median_amount":8331.7,"10th_percentile":8331.7,"90th_percentile":8331.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3832.16,"10th_percentile":3832.16,"90th_percentile":3832.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4396.68,"maximum":9626.85,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9210.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6239.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7002.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5942.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9626.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5942.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7131.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":5713.14},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":4931.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5817.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6818.04},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5942.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6833.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4396.68},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7041.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6120.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5472.27},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"1 through 10","median_amount":7409.46,"10th_percentile":7409.46,"90th_percentile":11234.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"1 through 10","median_amount":14031.83,"10th_percentile":14031.83,"90th_percentile":14031.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"29","median_amount":3168.22,"10th_percentile":3168.22,"90th_percentile":3832.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"34","median_amount":13205.89,"10th_percentile":8738.46,"90th_percentile":18106.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"1 through 10","median_amount":7449.91,"10th_percentile":5918.74,"90th_percentile":9791.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3168.22,"10th_percentile":3168.22,"90th_percentile":3832.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"1 through 10","median_amount":9143.0,"10th_percentile":6962.0,"90th_percentile":9143.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"808","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15803.76,"maximum":34559.85,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28748.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19475.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25171.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18547.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30047.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18547.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":22257.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":20535.73},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17727.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18158.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24507.28},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18547.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21329.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15803.76},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25308.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19104.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":19669.96},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8545.65,"maximum":18687.73,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16748.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11345.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13611.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10805.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17504.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10805.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":12966.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11104.39},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9585.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10578.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13251.95},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10805.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12426.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8545.65},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13685.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11129.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10636.24},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"810","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6566.73,"maximum":14585.14,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13954.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9453.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10459.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9003.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14585.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9003.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10803.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8532.94},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7366.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8814.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10183.19},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9003.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10353.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6566.73},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10516.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9273.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8173.2},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders With Mcc","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9706.92,"maximum":21227.21,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18511.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12540.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15460.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11943.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19347.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11943.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":14331.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":12613.37},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10888.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11692.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15052.76},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11943.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13734.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9706.92},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15545.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12301.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12081.6},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12062.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11943.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":18095.67},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19841.51},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11943.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21227.21},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11943.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12540.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17914.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12301.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20668.71},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":11943.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12062.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11943.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11172.98,"10th_percentile":11172.98,"90th_percentile":11172.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6368.01,"maximum":13925.64,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12319.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8345.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10142.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7947.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12875.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7947.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9537.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8274.72},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7143.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7780.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9875.03},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7947.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9140.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6368.01},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10198.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8186.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7925.87},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8027.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7947.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11871.26},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13016.58},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7947.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13925.64},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7947.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8345.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11921.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8186.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13559.25},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7947.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7947.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7478.85,"10th_percentile":7478.85,"90th_percentile":7478.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10680.51,"maximum":23356.26,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20053.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13584.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17011.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12937.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20958.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12937.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15524.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13878.47},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11980.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12665.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16562.53},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12937.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14878.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10680.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17104.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13325.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13293.37},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12135.32,"10th_percentile":12135.32,"90th_percentile":12135.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Mcc","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14423.07,"maximum":31540.54,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27714.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18774.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22972.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17880.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28966.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17880.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":21456.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":18741.63},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16178.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17504.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22366.21},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17880.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20562.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14423.07},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23097.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18416.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":17951.5},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8238.72,"10th_percentile":8238.72,"90th_percentile":8238.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Cc","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7011.09,"maximum":15331.93,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13539.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9172.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11166.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8735.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14151.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8735.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10482.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9110.35},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7864.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8551.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10872.27},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8735.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10045.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7011.09},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11227.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8997.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8726.27},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8822.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8735.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":13070.09},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14331.07},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8735.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15331.93},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8735.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9172.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13102.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8997.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14928.54},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8735.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8822.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8735.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","code_information":[{"code":"816","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4549.86,"maximum":9949.69,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8673.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5875.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7246.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5595.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9064.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5595.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":6714.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":5912.18},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5103.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5478.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7055.58},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5595.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6435.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4549.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7286.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5763.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5662.93},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5651.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5595.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":8481.86},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9300.18},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5595.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9949.69},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5595.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5875.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8393.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5763.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9687.9},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":5595.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5651.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5595.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"819","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5633.85,"maximum":12320.17,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11576.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7842.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8973.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7468.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12099.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7468.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8962.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7320.74},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6319.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7311.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8736.55},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7468.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8589.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5633.85},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9022.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7692.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7012.1},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","code_information":[{"code":"820","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40171.11,"maximum":87846.65,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75334.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51032.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63982.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48602.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78736.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48602.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":58323.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":52199.16},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":45061.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47582.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":62294.33},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48602.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55893.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40171.11},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64332.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50060.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":49998.48},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","code_information":[{"code":"823","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32286.48,"maximum":70604.45,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59028.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39986.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51424.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38082.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61694.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38082.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":45699.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":41953.71},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":36217.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37283.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50067.44},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38082.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43795.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32286.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51705.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39225.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":40184.97},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","code_information":[{"code":"824","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15175.17,"maximum":33185.24,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29483.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19972.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24170.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19021.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30815.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19021.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":22826.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":19718.92},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17022.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18622.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23532.51},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19021.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21875.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15175.17},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24302.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19592.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":18887.59},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","code_information":[{"code":"825","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8491.83,"maximum":18616.73,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17812.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12066.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13525.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11491.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18616.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11491.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13790.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11034.46},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9525.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11250.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13168.49},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11491.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13215.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8491.83},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13599.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11836.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10569.25},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","code_information":[{"code":"829","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21276.84,"maximum":46528.44,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40877.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27691.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33888.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26372.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42723.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26372.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":31647.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":27647.56},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23867.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25818.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32994.52},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26372.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30328.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21276.84},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34073.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27163.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":26481.96},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","code_information":[{"code":"830","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10090.56,"maximum":22066.15,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19794.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13409.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16071.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12770.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20688.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12770.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15324.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13111.88},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11318.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12502.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15647.68},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12770.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14686.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10090.56},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16159.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13153.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12559.09},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","code_information":[{"code":"831","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7941.21,"maximum":17365.93,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15940.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10798.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12648.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10284.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16660.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10284.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":12341.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":10318.97},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8907.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10068.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12314.63},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10284.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11827.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7941.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12717.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10593.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9883.93},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"1 through 10","median_amount":8244.75,"10th_percentile":8244.75,"90th_percentile":8244.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Cc","code_information":[{"code":"832","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5156.37,"maximum":11276.01,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9814.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6648.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8212.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6332.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10257.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6332.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7598.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6700.29},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5784.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6199.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7996.11},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6332.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7281.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5156.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8257.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6522.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6417.81},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6395.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6332.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":9612.52},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10539.92},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6332.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11276.01},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6332.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6648.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9498.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6522.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10979.33},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6332.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6395.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6332.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"1 through 10","median_amount":10417.36,"10th_percentile":10417.36,"90th_percentile":10417.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3056.34,"10th_percentile":3056.34,"90th_percentile":3056.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":20749.08,"10th_percentile":20749.08,"90th_percentile":20749.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","code_information":[{"code":"833","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3586.62,"maximum":7843.26,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7283.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4933.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5712.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4699.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7612.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4699.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":5638.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":4660.53},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":4023.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4600.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5561.86},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4699.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5403.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3586.62},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5743.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4839.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":4464.04},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"1 through 10","median_amount":13677.22,"10th_percentile":13677.22,"90th_percentile":13677.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2144.51,"10th_percentile":2144.51,"90th_percentile":2144.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":10983.45,"10th_percentile":7229.93,"90th_percentile":14022.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"1 through 10","median_amount":7022.87,"10th_percentile":4960.0,"90th_percentile":9920.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Acute Leukemia With Mcc","code_information":[{"code":"834","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38135.61,"maximum":83395.39,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70558.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47797.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60740.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45521.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":73744.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45521.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":54625.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":49554.19},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":42778.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44565.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":59137.83},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45521.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52349.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38135.61},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61072.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46887.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":47465.02},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Cc","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14737.02,"maximum":32227.09,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27193.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18421.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23472.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17544.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28421.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17544.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":21052.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":19149.58},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16531.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17175.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22853.06},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17544.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20175.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14737.02},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23600.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18070.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":18342.25},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17719.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17544.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":27472.8},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30123.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17544.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32227.09},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17544.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18421.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26316.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18070.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31379.17},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":17544.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17719.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17544.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia Without Cc/Mcc","code_information":[{"code":"836","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8767.83,"maximum":19173.59,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16157.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10945.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13964.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10424.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16887.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10424.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":12509.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11393.1},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9835.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13596.49},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10424.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11987.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8767.83},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14041.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10736.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10912.77},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10528.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10424.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":16345.01},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17921.95},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10424.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19173.59},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10424.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10945.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15636.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10736.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18669.12},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":10424.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10528.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10424.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","code_information":[{"code":"837","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34546.92,"maximum":75547.61,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61824.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41881.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55024.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39886.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64616.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39886.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":47864.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":44890.97},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":38752.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39049.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53572.76},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39886.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45869.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34546.92},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55325.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41083.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":42998.4},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","code_information":[{"code":"838","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13993.89,"maximum":30602.0,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27213.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18435.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22288.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17557.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28442.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17557.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":21068.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":18183.94},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15697.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17188.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21700.67},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17557.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20190.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13993.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22410.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18083.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":17417.32},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"839","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9455.07,"maximum":20676.46,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19016.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12881.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15059.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12268.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19874.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12268.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":14722.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":12286.11},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10606.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12010.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14662.21},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12268.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14108.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9455.07},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15141.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12636.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11768.14},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Mcc","code_information":[{"code":"840","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22006.86,"maximum":48124.86,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41831.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28337.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35051.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26988.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43721.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26988.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":32385.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":28596.16},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24685.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26421.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34126.58},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26988.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31036.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22006.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35242.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27797.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":27390.57},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Cc","code_information":[{"code":"841","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10818.51,"maximum":23658.04,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21404.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14499.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17231.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13809.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22371.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13809.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":16571.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14057.79},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12135.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13519.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16776.53},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13809.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15880.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10818.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17325.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14223.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13465.13},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13947.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13809.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":20167.9},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22113.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13809.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23658.04},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13809.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14499.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20714.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14223.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23035.59},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":13809.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13947.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13809.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","code_information":[{"code":"842","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7257.42,"maximum":15870.61,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13493.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9140.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11559.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8705.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14103.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8705.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10446.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9430.44},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8140.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8522.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11254.26},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8705.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10011.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7257.42},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11622.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8966.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9032.86},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8792.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8705.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":13529.3},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14834.59},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8705.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15870.61},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8705.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9140.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13058.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8966.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15453.05},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8705.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8792.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8705.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7488.65,"10th_percentile":7488.65,"90th_percentile":7488.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13062.39,"maximum":28564.99,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26034.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17636.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20805.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16796.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27209.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16796.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":20155.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":16973.53},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14652.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16443.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20256.17},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16796.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19315.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13062.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20918.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17300.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":16257.94},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","code_information":[{"code":"844","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8246.19,"maximum":18032.86,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16130.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10927.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13134.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10406.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16859.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10406.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":12488.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":10715.27},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9250.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10188.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12787.57},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10406.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11967.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8246.19},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13205.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10719.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10263.52},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","code_information":[{"code":"845","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5773.23,"maximum":12624.97,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11470.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7770.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9195.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7400.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11988.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7400.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8880.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7501.85},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6476.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7245.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8952.69},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7400.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8510.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5773.23},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9245.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7622.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7185.58},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","code_information":[{"code":"846","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17619.84,"maximum":38531.27,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33648.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22793.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28064.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21708.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35167.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21708.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":26050.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":22895.58},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19764.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21252.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27323.52},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21708.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24964.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17619.84},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28217.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22359.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":21930.32},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","code_information":[{"code":"847","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8767.14,"maximum":19172.08,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17287.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11710.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13963.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11153.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18068.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11153.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13383.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11392.2},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9834.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10918.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13595.42},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11153.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12826.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8767.14},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14040.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11487.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10911.91},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"848","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5650.41,"maximum":12356.38,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11442.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7751.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8999.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7382.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11959.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7382.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8858.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7342.26},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6338.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8762.23},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7382.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8489.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5650.41},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9048.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7603.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7032.71},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Radiotherapy","code_information":[{"code":"849","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18429.21,"maximum":40301.21,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35138.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23803.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29353.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22670.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36725.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22670.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":27204.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":23947.29},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20672.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22194.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28578.63},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22670.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26070.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18429.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29513.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23350.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":22937.69},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Other Procedures","code_information":[{"code":"850","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":63557.97,"maximum":138989.31,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110936.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75150.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101232.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71571.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":115946.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71571.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":85886.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":82588.52},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":71295.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70068.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":98560.91},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71571.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82307.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63557.97},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101784.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73718.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":79106.64},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34510.35,"maximum":75467.63,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63535.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43040.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54966.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40990.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66404.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40990.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":49188.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":44843.45},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":38711.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40129.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53516.05},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40990.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47139.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34510.35},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55266.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42220.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":42952.88},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41400.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40990.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":64334.29},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":70541.16},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40990.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":75467.63},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40990.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43040.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61485.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42220.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":73482.04},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":40990.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41400.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40990.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":29868.97,"10th_percentile":29868.97,"90th_percentile":29868.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":215848.25,"10th_percentile":215848.25,"90th_percentile":215848.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18793.97,"10th_percentile":18793.97,"90th_percentile":18793.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Cc","code_information":[{"code":"854","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13787.58,"maximum":30150.84,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26076.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17664.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21960.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16823.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27253.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16823.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":20187.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":17915.86},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15466.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16470.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21380.74},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16823.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19346.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13787.58},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22080.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17328.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":17160.54},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16991.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16823.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":25702.85},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28182.61},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16823.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30150.84},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16823.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17664.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25234.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17328.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29357.55},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":16823.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16991.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16823.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":80081.88,"10th_percentile":80081.88,"90th_percentile":80081.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"855","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11215.95,"maximum":24527.17,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19695.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13341.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17864.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12706.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20584.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12706.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15247.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14574.23},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12581.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12439.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17392.85},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12706.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14612.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11215.95},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17961.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13087.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13959.79},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12833.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12706.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":20908.81},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22926.05},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12706.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24527.17},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12706.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13341.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19059.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13087.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23881.85},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":12706.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12833.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12706.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12128.66,"10th_percentile":12128.66,"90th_percentile":12128.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","code_information":[{"code":"856","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31127.97,"maximum":68071.01,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58568.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39675.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49579.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37786.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61213.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37786.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":45343.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":40448.32},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":34917.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36992.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48270.91},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37786.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43454.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31127.97},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49849.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38919.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":38743.04},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38163.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37786.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":58028.85},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":63627.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37786.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":68071.01},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37786.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39675.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56679.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38919.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":66280.02},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":37786.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38163.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37786.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":15754.55,"10th_percentile":15754.55,"90th_percentile":15754.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"1 through 10","median_amount":27215.97,"10th_percentile":27215.97,"90th_percentile":27215.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","code_information":[{"code":"857","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15034.41,"maximum":32877.42,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27902.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18901.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23946.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18001.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29163.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18001.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":21602.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":19536.02},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16864.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17623.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23314.23},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18001.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20702.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15034.41},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24076.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18541.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":18712.39},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18181.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18001.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":28027.19},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30731.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18001.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32877.42},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18001.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18901.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27002.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18541.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32012.4},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":18001.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18181.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18001.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16859.18,"10th_percentile":16859.18,"90th_percentile":16859.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"858","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8889.96,"maximum":19440.67,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18366.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12441.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14159.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11849.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19195.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11849.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":14219.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11551.79},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9972.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11600.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13785.88},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11849.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13626.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8889.96},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14236.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12204.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11064.78},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11967.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11849.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":16572.69},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18171.59},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11849.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19440.67},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11849.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12441.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17774.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12204.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18929.17},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":11849.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11967.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11849.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12686.34,"maximum":27742.64,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23854.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16159.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20206.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15389.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24931.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15389.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18467.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":16484.89},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14230.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15066.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19673.02},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15389.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17698.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12686.34},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20316.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15851.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15789.9},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15543.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15389.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":23649.91},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25931.61},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15389.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27742.64},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15389.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16159.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23084.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15851.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27012.71},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":15389.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15543.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15389.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6899.31,"maximum":15087.49,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13334.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9033.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10988.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8602.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13936.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8602.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10323.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8965.1},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7739.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8422.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10698.93},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8602.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9893.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6899.31},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11048.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8861.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8587.14},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8688.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8602.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":12861.71},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14102.59},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8602.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15087.49},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8602.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9033.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12904.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8861.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14690.53},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8602.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8688.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8602.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fever And Inflammatory Conditions","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6195.51,"maximum":13548.41,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11930.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8082.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9867.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7697.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12469.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7697.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9236.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8050.57},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6949.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7535.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9607.53},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7697.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8851.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6195.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9921.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7928.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7711.17},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness With Mcc","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10183.71,"maximum":22269.86,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19709.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13351.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16220.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12715.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20599.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12715.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15258.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13232.92},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11423.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12448.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15792.13},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12715.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14622.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10183.71},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16308.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13097.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12675.03},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12842.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12715.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":18984.5},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20816.09},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12715.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22269.86},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12715.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13351.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19073.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13097.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21683.92},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":12715.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12842.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12715.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness Without Mcc","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6104.43,"maximum":13349.24,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11700.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7925.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9722.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7548.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12228.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7548.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9058.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7932.22},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6847.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7389.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9466.29},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7548.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8680.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6104.43},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9775.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7774.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7597.8},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7623.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7548.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11379.9},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12477.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7548.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13349.24},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7548.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7925.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11322.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7774.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12998.01},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7548.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7623.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7548.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Mcc","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14794.98,"maximum":32353.83,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27287.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18485.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23564.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17604.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28519.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17604.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":21125.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":19224.9},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16596.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17235.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22942.94},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17604.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20245.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14794.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23693.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18133.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":18414.39},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Cc","code_information":[{"code":"868","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7245.0,"maximum":15843.45,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13757.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9319.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11539.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8875.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14378.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8875.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10650.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9414.3},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8127.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8689.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11235.0},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8875.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10207.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7245.0},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11602.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9142.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9017.4},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8964.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8875.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":13506.15},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14809.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8875.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15843.45},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8875.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9319.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13313.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9142.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15426.6},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8875.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8964.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8875.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4964.55,"maximum":10856.54,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9917.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6718.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7907.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6398.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10365.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6398.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7678.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6451.04},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5568.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6264.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7698.65},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6398.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7358.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4964.55},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7950.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6590.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6179.07},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6462.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6398.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":9254.93},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10147.83},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6398.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10856.54},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6398.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6718.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9597.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6590.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10570.89},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6398.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6462.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6398.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47999.85,"maximum":104966.63,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88672.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60068.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76451.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57207.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":92676.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57207.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":68649.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":62371.98},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":53843.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56006.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":74434.55},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57207.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65789.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47999.85},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76869.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58924.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":59742.42},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43030.23,"10th_percentile":43030.23,"90th_percentile":43030.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13539.87,"maximum":29609.14,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25367.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17184.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21565.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16366.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26513.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16366.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":19639.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":17593.98},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15188.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16022.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20996.61},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16366.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18821.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13539.87},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21683.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16857.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":16852.23},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"1 through 10","median_amount":19445.21,"10th_percentile":19445.21,"90th_percentile":19445.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15304.28,"10th_percentile":15304.28,"90th_percentile":15304.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"1 through 10","median_amount":21301.69,"10th_percentile":21301.69,"90th_percentile":21301.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12588.9,"10th_percentile":12588.9,"90th_percentile":12588.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15616.61,"10th_percentile":15616.61,"90th_percentile":15616.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":40546.94,"10th_percentile":40546.94,"90th_percentile":40546.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"1 through 10","median_amount":32497.36,"10th_percentile":32497.36,"90th_percentile":32497.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8896.23,"10th_percentile":8896.23,"90th_percentile":10248.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2851.39,"10th_percentile":2851.39,"90th_percentile":2851.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":22030.04,"10th_percentile":22030.04,"90th_percentile":22030.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"1 through 10","median_amount":21803.07,"10th_percentile":21803.07,"90th_percentile":21803.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7113.9,"maximum":15556.76,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13658.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9252.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11330.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8811.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14274.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8811.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10574.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9243.95},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7979.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8626.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11031.7},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8811.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10133.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7113.9},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11392.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9076.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8854.23},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8239.96,"10th_percentile":8239.96,"90th_percentile":8416.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":24718.57,"10th_percentile":24718.57,"90th_percentile":24718.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8335.87,"10th_percentile":8335.87,"90th_percentile":8335.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"1 through 10","median_amount":9920.0,"10th_percentile":9920.0,"90th_percentile":9920.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"O.R. Procedures With Principal Diagnosis Of Mental Illness","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27112.86,"maximum":59290.72,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49857.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33774.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43184.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32166.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52109.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32166.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":38599.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":35231.0},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30413.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31490.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42044.58},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32166.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36991.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27112.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43419.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33131.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":33745.69},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Adjustment Reaction And Psychosocial Dysfunction","code_information":[{"code":"880","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6614.34,"maximum":14464.32,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12854.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8707.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10535.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13434.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9951.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8594.81},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7419.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8118.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10257.02},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9537.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6614.34},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10592.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8541.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8232.46},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8376.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":12330.47},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13520.09},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14464.32},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8707.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12439.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8541.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14083.75},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8293.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8376.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"1 through 10","median_amount":6714.0,"10th_percentile":6714.0,"90th_percentile":6714.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6307.29,"maximum":13792.85,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12608.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8541.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10045.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8134.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13177.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8134.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9761.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8195.82},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7075.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7963.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9780.87},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8134.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9354.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6307.29},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10100.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8378.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7850.29},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8215.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8134.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11758.07},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12892.47},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8134.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13792.85},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8134.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8541.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12201.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8378.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13429.96},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8134.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8215.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8134.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1926.63,"10th_percentile":1926.63,"90th_percentile":1926.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6382.81,"10th_percentile":6382.81,"90th_percentile":6382.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3118.5,"10th_percentile":3118.5,"90th_percentile":5614.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":19155.35,"10th_percentile":12462.54,"90th_percentile":30377.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"1 through 10","median_amount":24053.95,"10th_percentile":24053.95,"90th_percentile":24053.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Neuroses Except Depressive","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6637.11,"maximum":14947.29,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14301.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9688.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10571.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9226.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14947.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9226.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11072.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8624.4},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7445.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9032.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10292.33},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9226.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10610.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6637.11},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10629.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9503.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8260.8},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9318.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9226.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":12372.92},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13566.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9226.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14514.11},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9226.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9688.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13840.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9503.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14132.23},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":9226.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9318.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9226.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Personality And Impulse Control","code_information":[{"code":"883","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12809.16,"maximum":28011.22,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25671.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17390.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20401.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16561.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26830.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16561.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":19874.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":16644.48},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14368.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16214.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19863.48},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16561.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19046.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12809.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20513.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17058.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15942.76},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16727.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16561.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":23878.87},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26182.67},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16561.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28011.22},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16561.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17390.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24842.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17058.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27274.23},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":16561.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16727.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16561.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Organic Disturbances And Intellectual Disability","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11523.69,"maximum":25200.14,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21118.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14305.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18354.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13624.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22071.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13624.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":16349.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14974.12},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12926.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13338.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17870.07},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13624.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15668.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11523.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18454.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14033.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14342.82},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9725.55,"maximum":21267.95,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18416.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12475.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15490.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11881.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19247.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11881.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":14257.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":12637.58},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10909.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11631.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15081.65},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11881.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13663.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9725.55},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15574.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12237.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12104.79},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2569.64,"10th_percentile":2569.64,"90th_percentile":5781.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"1 through 10","median_amount":15350.83,"10th_percentile":15350.83,"90th_percentile":15350.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"1 through 10","median_amount":20880.49,"10th_percentile":20880.49,"90th_percentile":20880.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4989.6,"10th_percentile":3118.5,"90th_percentile":7484.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10486.79,"10th_percentile":10486.79,"90th_percentile":10486.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":18596.69,"10th_percentile":16039.05,"90th_percentile":48774.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"1 through 10","median_amount":11190.0,"10th_percentile":11190.0,"90th_percentile":11190.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4365.9,"10th_percentile":4365.9,"90th_percentile":4365.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3929.34,"10th_percentile":3929.34,"90th_percentile":5239.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"1 through 10","median_amount":6685.0,"10th_percentile":6685.0,"90th_percentile":24930.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12395.16,"maximum":28281.65,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27059.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18330.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19742.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17457.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28281.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17457.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":20949.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":16106.52},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13904.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17091.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19221.48},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17457.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20076.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12395.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19850.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17981.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15427.48},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17632.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17457.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":23107.09},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25336.43},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17457.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27105.88},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17457.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18330.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26186.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17981.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26392.71},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":17457.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17632.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17457.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Mental Disorder Diagnoses","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8206.17,"maximum":17945.35,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14264.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9663.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13070.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9202.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14908.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9202.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11043.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":10663.26},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9205.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9009.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12725.51},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9202.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10583.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8206.17},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13141.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9478.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10213.71},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9294.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9202.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":15297.97},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16773.89},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9202.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17945.35},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9202.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9663.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13804.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9478.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17473.2},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":9202.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9294.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9202.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence, Left Ama","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4306.29,"maximum":9417.04,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8480.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5745.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6858.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5471.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8863.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5471.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":6565.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":5595.68},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":4830.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5356.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6677.87},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5471.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6292.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4306.29},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6896.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5635.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5359.77},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5526.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5471.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":8027.8},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8802.31},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5471.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9417.04},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5471.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5745.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8207.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5635.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9169.28},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":5471.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5526.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5471.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"1 through 10","median_amount":43598.54,"10th_percentile":43598.54,"90th_percentile":43598.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","code_information":[{"code":"895","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9990.51,"maximum":21847.36,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18655.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12637.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15912.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12035.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19498.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12035.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":14443.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":12981.87},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11206.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11783.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15492.53},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12035.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13841.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9990.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15999.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12396.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12434.57},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12156.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12035.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":18624.34},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20421.18},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12035.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21847.36},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12035.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12637.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18053.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12396.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21272.55},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":12035.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12156.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12035.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12287.52,"maximum":26870.49,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22853.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15481.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19570.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14743.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23885.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14743.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":17692.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15966.65},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13783.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14434.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19054.56},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14743.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16955.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12287.52},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19677.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15186.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15293.51},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":28120.27,"10th_percentile":28120.27,"90th_percentile":28120.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3446.87,"10th_percentile":3446.87,"90th_percentile":3446.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6087.18,"maximum":13311.52,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11868.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8039.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9695.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7656.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12404.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7656.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9188.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7909.81},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6828.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7496.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9439.54},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7656.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8805.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6087.18},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9748.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7886.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7576.33},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"1 through 10","median_amount":44279.29,"10th_percentile":44279.29,"90th_percentile":44279.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3446.87,"10th_percentile":3446.87,"90th_percentile":3446.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":13599.77,"10th_percentile":9688.03,"90th_percentile":30895.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"1 through 10","median_amount":3651.99,"10th_percentile":3651.99,"90th_percentile":3651.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2516.45,"10th_percentile":2516.45,"90th_percentile":2516.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30568.38,"maximum":66847.29,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54083.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36636.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48687.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34892.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56525.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34892.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":41870.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":39721.17},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":34289.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34159.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47403.14},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34892.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40126.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30568.38},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48953.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35939.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":38046.56},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35241.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34892.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":56985.66},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":62483.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34892.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":66847.29},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34892.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36636.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52338.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35939.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":65088.5},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":34892.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35241.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34892.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33272.52,"10th_percentile":33272.52,"90th_percentile":33272.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13092.06,"maximum":28629.87,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25011.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16943.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20852.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16136.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26140.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16136.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":19363.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":17012.09},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14685.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15797.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20302.18},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16136.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18556.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13092.06},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20966.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16620.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":16294.87},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16297.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16136.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":24406.26},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26760.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16136.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28629.87},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16136.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16943.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24204.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16620.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27876.6},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":16136.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16297.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16136.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries Without Cc/Mcc","code_information":[{"code":"903","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8411.1,"maximum":18393.49,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15521.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10514.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13396.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10014.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16222.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10014.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":12016.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":10929.55},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9435.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9803.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13043.3},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10014.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11516.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8411.1},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13469.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10314.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10468.77},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10114.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10014.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":15680.0},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17192.78},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10014.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18393.49},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10014.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10514.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15021.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10314.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17909.55},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":10014.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10114.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10014.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries With Cc/Mcc","code_information":[{"code":"904","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26640.21,"maximum":58257.12,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47414.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32119.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42431.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30589.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49555.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30589.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":36707.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":34616.83},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":29883.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29947.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41311.63},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30589.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35178.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26640.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42662.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31507.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":33157.41},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30895.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30589.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":49662.76},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":54454.13},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30589.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58257.12},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30589.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32119.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45884.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31507.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":56724.34},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":30589.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30895.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30589.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries Without Cc/Mcc","code_information":[{"code":"905","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11371.89,"maximum":24868.18,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19519.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13222.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18112.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12593.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20400.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12593.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15111.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14776.86},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12756.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12328.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17634.67},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12593.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14482.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11371.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18211.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12970.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14153.88},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12719.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12593.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":21199.51},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23244.8},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12593.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24868.18},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12593.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13222.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18889.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12970.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24213.89},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":12593.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12719.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12593.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Procedures For Injuries","code_information":[{"code":"906","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15058.56,"maximum":32930.23,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25645.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17372.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23984.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16545.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26803.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16545.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":19854.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":19567.4},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16891.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16198.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23351.68},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16545.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19027.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15058.56},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24115.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17041.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":18742.45},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16710.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16545.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":28072.21},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30780.57},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16545.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32930.23},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16545.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17372.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24818.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17041.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32063.82},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":16545.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16710.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16545.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Mcc","code_information":[{"code":"907","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27486.15,"maximum":60107.03,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49531.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33553.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43778.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31955.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51768.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31955.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":38346.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":35716.06},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30832.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31284.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42623.45},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31955.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36749.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27486.15},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44017.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32914.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":34210.3},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Cc","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13917.3,"maximum":30434.51,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26039.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17639.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22166.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16799.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27215.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16799.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":20159.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":18084.42},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15611.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16446.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21581.9},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16799.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19319.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13917.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22287.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17303.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":17322.0},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16967.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16799.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":25944.67},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28447.77},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16799.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30434.51},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16799.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17639.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25199.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17303.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29633.76},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":16799.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16967.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16799.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15750.82,"10th_percentile":15750.82,"90th_percentile":15750.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8750.58,"maximum":19135.87,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17344.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11749.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13937.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11190.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18128.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11190.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13428.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11370.68},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9815.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10955.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13569.74},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11190.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12868.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8750.58},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14013.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11525.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":10891.3},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury With Mcc","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11165.58,"maximum":24417.02,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21445.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14527.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17784.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13835.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22414.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13835.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":16602.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14508.78},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12524.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13545.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17314.74},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13835.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15911.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11165.58},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17881.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14250.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13897.1},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13974.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13835.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":20814.91},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22823.09},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13835.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24417.02},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13835.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14527.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20753.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14250.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23774.59},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":13835.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13974.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13835.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury Without Mcc","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6322.47,"maximum":13826.05,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11902.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8063.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10070.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7679.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12440.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7679.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9214.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8215.55},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7092.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7517.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9804.41},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7679.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8831.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6322.47},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10125.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7909.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7869.18},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7755.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7679.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11786.37},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12923.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7679.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13826.05},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7679.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8063.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11518.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7909.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13462.28},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7679.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7755.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7679.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions With Mcc","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11990.82,"maximum":26221.66,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22044.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14933.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19098.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14222.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23039.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14222.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":17066.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15581.11},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13450.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13923.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18594.46},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14222.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16355.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11990.82},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19202.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14648.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14924.23},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14364.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14222.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":22353.32},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24509.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14222.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26221.66},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14222.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14933.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21333.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14648.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25531.76},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":14222.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14364.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14222.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions Without Mcc","code_information":[{"code":"916","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4581.6,"maximum":10019.1,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9110.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6171.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7297.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5877.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9521.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5877.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7053.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":5953.42},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5139.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5754.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7104.8},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5877.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6759.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4581.6},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7337.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6053.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5702.43},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5936.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5877.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":8541.03},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9365.06},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5877.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10019.1},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5877.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6171.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8816.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6053.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9755.49},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":5877.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5936.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5877.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11313.24,"maximum":24739.92,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20602.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13956.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18019.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13291.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21532.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13291.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15950.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14700.65},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12690.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13012.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17543.72},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13291.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15285.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11313.24},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18117.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13690.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14080.88},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13424.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13291.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":21090.17},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23124.92},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13291.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24739.92},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13291.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13956.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19937.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13690.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24089.0},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":13291.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13424.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13291.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"1 through 10","median_amount":14090.18,"10th_percentile":14090.18,"90th_percentile":14090.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6102.36,"maximum":13344.71,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11540.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7818.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9719.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12062.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8934.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7929.53},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6845.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7289.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9463.08},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8562.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6102.36},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9772.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7669.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7595.23},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7520.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11376.04},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12473.58},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13344.71},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7818.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11168.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7669.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12993.6},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7445.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7520.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7669.84,"10th_percentile":7669.84,"90th_percentile":7669.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12581.46,"maximum":27513.28,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23944.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16220.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20039.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15448.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25026.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15448.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":18537.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":16348.6},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14113.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15123.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19510.38},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15448.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17765.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12581.46},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20148.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15911.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":15659.36},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15602.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15448.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":23454.39},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25717.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15448.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27513.28},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15448.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16220.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23172.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15911.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26789.39},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":15448.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15602.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15448.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6554.49,"10th_percentile":6554.49,"90th_percentile":6554.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7009.02,"maximum":15327.41,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13390.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9071.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11163.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8639.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13995.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8639.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10366.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9107.66},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7862.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8457.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10869.06},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8639.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9934.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7009.02},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11224.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8898.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8723.69},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8725.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8639.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":13066.24},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14326.84},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8639.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15327.41},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8639.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9071.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12958.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8898.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14924.13},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8639.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8725.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8639.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4655.48,"10th_percentile":4655.48,"90th_percentile":4655.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4744.44,"maximum":10375.2,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9391.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6362.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7556.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6059.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9815.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6059.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":7271.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":6165.02},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5322.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5931.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7357.32},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6059.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6968.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4744.44},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7597.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6240.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5905.11},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6119.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6059.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":8844.6},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9697.91},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6059.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10375.2},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6059.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6362.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9088.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6240.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10102.22},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6059.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6119.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6059.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11655.48,"maximum":25488.34,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22907.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15518.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18564.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14779.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23942.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14779.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":17735.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":15145.37},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13074.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14468.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18074.44},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14779.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16996.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11655.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18665.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15222.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14506.85},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","code_information":[{"code":"923","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7036.62,"maximum":15387.76,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13586.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9203.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11207.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8765.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14200.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8765.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":10518.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9143.53},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7893.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8581.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10911.86},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8765.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10080.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7036.62},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11268.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9028.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8758.04},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","code_information":[{"code":"927","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":163687.32,"maximum":357953.33,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":272608.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":184669.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":260713.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175876.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":284919.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175876.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":211051.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":212698.62},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":183614.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":172182.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":253833.96},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175876.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":202257.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":163687.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":262136.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":181152.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":203731.41},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177634.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175876.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":305146.38},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":334586.37},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175876.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":357953.33},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175876.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":184669.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":263814.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":181152.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":348535.38},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":175876.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177634.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175876.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","code_information":[{"code":"928","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46081.65,"maximum":100771.89,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91995.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62319.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73396.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59352.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":96150.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59352.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":71222.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":59879.43},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":51691.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58105.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":71459.95},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59352.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68254.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46081.65},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73797.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61132.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":57354.96},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59945.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59352.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":85905.55},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":94193.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59352.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":100771.89},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59352.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62319.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":89028.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61132.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":98120.52},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":59352.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59945.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59352.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21943.38,"maximum":47986.04,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41652.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28216.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34950.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26872.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43533.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26872.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":32246.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":28513.67},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24614.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26308.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34028.14},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26872.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30903.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21943.38},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35141.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27678.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":27311.56},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27141.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26872.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":40906.91},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":44853.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26872.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47986.04},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26872.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28216.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40308.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27678.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46723.5},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":26872.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27141.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26872.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","code_information":[{"code":"933","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29854.23,"maximum":65285.58,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50230.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34027.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47550.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32406.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52499.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32406.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":38888.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":38793.19},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":33488.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31726.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46295.69},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32406.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37267.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29854.23},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47810.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33379.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":37157.7},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32730.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32406.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":55654.34},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":61023.78},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32406.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":65285.58},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32406.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34027.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48610.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33379.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":63567.88},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":32406.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32730.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32406.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn Without Skin Graft Or Inhalation Injury","code_information":[{"code":"934","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14805.33,"maximum":32376.47,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28783.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19498.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23581.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18569.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30083.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18569.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":22283.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":19238.35},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16607.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18179.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22958.99},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18569.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21355.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14805.33},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23709.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19126.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":18427.27},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18755.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18569.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":27600.14},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30262.95},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18569.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32376.47},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18569.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19498.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27854.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19126.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31524.62},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":18569.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18755.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18569.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive Burns","code_information":[{"code":"935","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15154.47,"maximum":33139.97,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26864.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18198.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24137.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17332.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28077.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17332.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":20798.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":19692.03},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16999.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16968.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23500.41},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17332.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19931.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15154.47},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24269.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17852.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":18861.82},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17505.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17332.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":28251.01},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30976.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17332.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33139.97},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17332.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18198.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25998.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17852.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32268.04},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":17332.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17505.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17332.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","code_information":[{"code":"939","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21899.22,"maximum":48961.58,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46845.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31734.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34880.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30223.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48961.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30223.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":36267.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":28456.29},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24565.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29588.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33959.66},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30223.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34756.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21899.22},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35070.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31129.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":27256.59},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14567.97,"maximum":31857.41,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30392.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20588.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23203.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19607.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31764.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19607.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":23529.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":18929.92},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16341.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19196.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22590.91},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19607.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22549.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14567.97},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23329.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20196.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":18131.84},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","code_information":[{"code":"941","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13483.98,"maximum":29486.92,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26453.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17919.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21476.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17066.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27647.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17066.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":20479.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":17521.36},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15125.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16708.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20909.94},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17066.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19626.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13483.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21593.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17578.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":16782.67},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation With Cc/Mcc","code_information":[{"code":"945","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10532.16,"maximum":23031.85,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20349.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13785.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16775.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13128.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21268.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13128.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15754.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13685.7},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11814.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12853.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16332.48},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13128.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15098.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10532.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16866.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13522.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":13108.72},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation Without Cc/Mcc","code_information":[{"code":"946","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7703.16,"maximum":16845.36,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15231.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10318.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12269.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9826.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15919.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9826.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":11792.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":10009.64},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8640.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9620.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11945.48},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9826.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11300.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7703.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12336.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10121.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9587.64},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9924.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9826.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":14360.25},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15745.71},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9826.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16845.36},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9826.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10318.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14740.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10121.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16402.15},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":9826.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9924.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9826.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8874.09,"maximum":19405.96,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16793.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11376.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14134.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10834.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17551.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10834.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13001.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":11531.17},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9954.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10606.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13761.27},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10834.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12459.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8874.09},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14211.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11159.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":11045.03},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10942.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10834.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":16543.1},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18139.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10834.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19405.96},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10834.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11376.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16251.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11159.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18895.38},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":10834.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10942.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10834.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5482.05,"maximum":11988.21,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10819.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8731.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6980.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11308.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6980.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":8376.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":7123.49},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6149.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6833.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8501.15},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6980.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8027.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5482.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8779.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7189.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":6823.17},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7050.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6980.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":10219.65},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11205.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6980.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11988.21},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6980.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10470.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7189.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11672.79},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":6980.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7050.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6980.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6538.12,"10th_percentile":6538.12,"90th_percentile":6538.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5617.42,"10th_percentile":5617.42,"90th_percentile":5617.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7444.41,"maximum":16490.42,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15777.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10688.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11857.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10179.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16490.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10179.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":12215.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":9673.42},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8350.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9965.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11544.23},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10179.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11706.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7444.41},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11921.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10484.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":9265.59},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10281.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10179.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":13877.89},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15216.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10179.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16279.52},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10179.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10688.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15268.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10484.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15851.2},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":10179.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10281.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10179.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4044.09,"maximum":9007.73,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8618.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5838.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6441.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5560.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9007.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5560.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":6672.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":5254.97},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":4536.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5443.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6271.27},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5560.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6394.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4044.09},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6476.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5727.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":5033.43},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Factors Influencing Health Status","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3911.61,"maximum":8553.95,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7705.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5219.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6230.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4971.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8053.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4971.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":5965.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":5082.83},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":4387.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4866.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6065.83},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4971.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5716.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3911.61},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6264.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5120.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":4868.54},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47112.51,"maximum":103026.18,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86370.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58508.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75038.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55722.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":90270.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55722.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":66867.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":61218.95},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":52847.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54552.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":73058.53},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55722.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64081.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47112.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75448.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57394.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":58638.01},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26373.18,"maximum":57673.18,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48559.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32895.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42005.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31328.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50752.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31328.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":37594.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":34269.85},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":29583.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30670.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40897.54},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31328.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36027.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26373.18},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42235.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32268.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":32825.05},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"959","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18241.53,"maximum":39890.79,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38127.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25828.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29054.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24598.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39849.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24598.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":29517.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":23703.41},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20462.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24081.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28287.59},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24598.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28288.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18241.53},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29212.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25336.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":22704.1},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24844.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24598.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":34005.91},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":37286.74},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24598.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39890.79},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24598.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25828.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36897.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25336.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38841.24},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":24598.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24844.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24598.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Mcc","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18744.54,"maximum":40990.78,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35448.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24013.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29855.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22869.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37049.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22869.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":27443.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":24357.04},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21026.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22389.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29067.62},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22869.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26300.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18744.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30018.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23555.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":23330.16},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23098.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22869.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":34943.63},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":38314.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22869.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40990.78},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22869.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24013.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34304.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23555.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39912.29},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":22869.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23098.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22869.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Cc","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10351.38,"maximum":22636.52,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20146.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13647.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16487.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12997.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21055.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12997.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":15596.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":13450.79},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11611.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12724.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16052.14},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12997.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14947.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10351.38},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16577.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13387.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12883.72},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13127.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12997.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":19297.07},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21158.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12997.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22636.52},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12997.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13647.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19496.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13387.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22040.94},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":12997.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13127.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12997.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6296.25,"maximum":13768.71,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12603.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8537.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10028.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8131.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13172.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8131.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9757.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8181.48},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7062.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7960.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9763.75},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8131.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9350.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6296.25},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10083.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8375.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":7836.55},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8212.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8131.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":11737.49},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12869.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8131.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13768.71},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8131.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8537.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12196.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8375.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13406.45},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":8131.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8212.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8131.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures Without Mcc","code_information":[{"code":"970","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18307.08,"maximum":40034.13,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34220.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23181.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29158.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22077.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35765.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22077.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":26493.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":23788.59},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20535.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21613.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28389.24},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22077.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25389.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18307.08},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29317.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22739.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":22785.68},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20603.4,"maximum":45055.75,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37387.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25326.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32816.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24120.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39075.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24120.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":28944.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":26772.48},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23111.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23614.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31950.2},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24120.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27738.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20603.4},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32995.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24844.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":25643.77},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24361.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24120.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":38408.92},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":42114.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24120.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45055.75},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24120.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25326.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36181.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24844.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43870.31},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":24120.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24361.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24120.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9806.97,"maximum":21446.0,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17119.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11596.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15620.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11044.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17892.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11044.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13253.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":12743.38},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11000.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10812.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15207.91},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11044.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12701.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9806.97},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15705.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11376.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12206.12},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11155.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11044.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":18282.18},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20046.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11044.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21446.0},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11044.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11596.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16567.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11376.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20881.74},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":11044.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11155.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11044.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition Without Cc/Mcc","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6920.01,"maximum":15132.76,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12121.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8211.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11021.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7820.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12669.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7820.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":9384.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":8992.0},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7762.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7656.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10731.03},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7820.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8993.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6920.01},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11082.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8055.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":8612.91},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7898.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7820.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":12900.3},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14144.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7820.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15132.76},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7820.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8211.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11730.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8055.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14734.61},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":7820.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7898.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7820.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Or Without Other Related Condition","code_information":[{"code":"977","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9948.42,"maximum":21755.32,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17153.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11620.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15845.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11066.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17928.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11066.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":13280.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":12927.18},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11159.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10834.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15427.26},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11066.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12726.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9948.42},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15931.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11398.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":12382.18},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11177.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11066.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":18545.87},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20335.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11066.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21755.32},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11066.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11620.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16600.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11398.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21182.93},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":11066.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11177.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11066.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32804.67,"maximum":71737.63,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60391.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40910.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52249.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38962.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63118.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38962.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":46754.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":42627.05},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":36798.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38144.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50871.01},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38962.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44806.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32804.67},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52535.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40131.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":40829.93},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39351.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38962.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":61154.56},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":67054.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38962.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":71737.63},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38962.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40910.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58443.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40131.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":69850.18},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":38962.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39351.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38962.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16894.65,"maximum":36945.42,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31941.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21637.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26909.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20607.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33383.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20607.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":24728.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":21953.25},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18951.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20174.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26198.95},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20607.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23698.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16894.65},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27055.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21225.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":21027.72},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20813.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20607.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":31495.06},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":34533.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20607.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36945.42},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20607.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21637.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30910.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21225.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35973.36},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":20607.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20813.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20607.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9988.47,"10th_percentile":9988.47,"90th_percentile":9988.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11509.89,"maximum":25169.96,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22456.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15212.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18332.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14488.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23471.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14488.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":17386.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":14956.18},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12911.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14184.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17848.67},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14488.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16661.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11509.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18432.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14923.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":14325.64},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14633.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14488.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":21456.77},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23526.88},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14488.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25169.96},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14488.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15212.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21732.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14923.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24507.73},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":14488.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14633.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14488.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":102739.43,"10th_percentile":102739.43,"90th_percentile":102739.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24170.7,"maximum":52856.77,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44296.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30007.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38497.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28578.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46297.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28578.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":34294.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Choice / Mcnp Pos","methodology":"fee schedule","standard_charge_dollar":31407.9},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27113.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27978.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37482.1},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28578.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32865.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24170.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38708.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29435.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"One Health Hmo","methodology":"fee schedule","standard_charge_dollar":30083.76},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28864.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28578.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Hfn","plan_name":"20 Ppo","methodology":"fee schedule","standard_charge_dollar":45059.09},{"payer_name":"Humana","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":49406.31},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28578.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52856.77},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28578.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30007.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42867.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29435.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51466.08},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":28578.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28864.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28578.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone marrow transplant","code_information":[{"code":"009","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyphema","code_information":[{"code":"043","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections","code_information":[{"code":"044","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological eye disorders","code_information":[{"code":"045","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w CC","code_information":[{"code":"046","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w/o CC","code_information":[{"code":"047","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age 0-17","code_information":[{"code":"048","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures","code_information":[{"code":"049","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sialoadenectomy","code_information":[{"code":"050","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures Except Sialoadenectomy","code_information":[{"code":"051","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","code_information":[{"code":"104","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","code_information":[{"code":"105","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass w PTCA","code_information":[{"code":"106","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"107","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures","code_information":[{"code":"108","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"109","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w CC","code_information":[{"code":"110","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w/o CC","code_information":[{"code":"111","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"112","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement","code_information":[{"code":"118","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein ligation & stripping","code_information":[{"code":"119","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other circulatory system O.R. procedures","code_information":[{"code":"120","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute & Subacute Endocarditis","code_information":[{"code":"126","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure & Shock","code_information":[{"code":"127","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis","code_information":[{"code":"128","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W Cc/Mcc Or Major Device","code_information":[{"code":"129","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W/O Cc/Mcc","code_information":[{"code":"130","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W Cc/Mcc","code_information":[{"code":"131","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W/O Cc/Mcc","code_information":[{"code":"132","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","code_information":[{"code":"133","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","code_information":[{"code":"134","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","code_information":[{"code":"160","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w CC","code_information":[{"code":"161","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","code_information":[{"code":"162","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures w/o CC","code_information":[{"code":"169","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures w/o CC","code_information":[{"code":"171","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"G.I. hemorrhage w CC","code_information":[{"code":"174","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":91465.97,"maximum":151353.30,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":144813.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98099.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93427.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":151353.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93427.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":112113.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91465.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93427.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":107442.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":96230.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94362.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93427.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93427.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93427.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98099.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":140141.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":96230.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":93427.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94362.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93427.96,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w CC","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","code_information":[{"code":"211","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":46311.66,"maximum":76634.21,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73322.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49670.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47305.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76634.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47305.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":56766.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46311.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47305.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54400.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48724.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47778.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47305.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47305.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47305.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49670.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70957.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48724.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":47305.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47778.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47305.07,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"No Longer Valid","code_information":[{"code":"214","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","code_information":[{"code":"222","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","code_information":[{"code":"223","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","code_information":[{"code":"224","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","code_information":[{"code":"225","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","code_information":[{"code":"226","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","code_information":[{"code":"227","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other cardiothoracic procedures w/o CC/MCC","code_information":[{"code":"230","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w MCC","code_information":[{"code":"237","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w/o MCC","code_information":[{"code":"238","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"246","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","code_information":[{"code":"247","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"248","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","code_information":[{"code":"249","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy Without Intraluminal Device","code_information":[{"code":"318","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":19882.41,"maximum":32900.42,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31478.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21324.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20308.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32900.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20308.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":24370.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19882.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20308.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23355.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20918.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20511.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20308.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20308.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20308.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21324.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30463.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20918.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":20308.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20511.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20308.9,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Mcc","code_information":[{"code":"338","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Cc","code_information":[{"code":"339","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"340","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Mcc","code_information":[{"code":"341","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Cc","code_information":[{"code":"342","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"343","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","code_information":[{"code":"359","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":28060.54,"maximum":46433.17,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44426.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30095.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28662.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46433.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28662.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":34394.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28060.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28662.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32961.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29522.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28949.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28662.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28662.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28662.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30095.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42993.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29522.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":28662.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28949.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28662.45,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","code_information":[{"code":"360","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":19818.85,"maximum":32795.23,"payers_information":[{"payer_name":"Actin Care","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31378.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21256.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20243.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32795.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension Complete","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20243.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Access Community Health Hmo","methodology":"fee schedule","standard_charge_dollar":24292.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19818.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20243.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Villagemd Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23280.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20851.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20446.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20243.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20243.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20243.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21256.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30365.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20851.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Triwest","plan_name":"Government","methodology":"fee schedule","standard_charge_dollar":20243.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20446.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20243.97,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Laparoscopy & Incisional Tubal Interruption","code_information":[{"code":"361","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endoscopic Tubal Interruption","code_information":[{"code":"362","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization & Radio-Implant, for Malignancy","code_information":[{"code":"363","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization Except for Malignancy","code_information":[{"code":"364","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures","code_information":[{"code":"365","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, female reproductive system w CC","code_information":[{"code":"366","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System w/o CC","code_information":[{"code":"367","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Age 0-17","code_information":[{"code":"396","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"400","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w other O.R. proc w CC","code_information":[{"code":"401","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w CC","code_information":[{"code":"403","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & Non-Acute Leukemia w/o CC","code_information":[{"code":"404","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Childhood Mental Disorders","code_information":[{"code":"431","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning & toxic Effects of Drugs Age >17 w CC","code_information":[{"code":"449","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications of treatment w CC","code_information":[{"code":"452","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Mcc","code_information":[{"code":"453","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Cc","code_information":[{"code":"454","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":55804.35,"10th_percentile":55804.35,"90th_percentile":55804.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":56943.21,"10th_percentile":56943.21,"90th_percentile":56943.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":318120.8,"10th_percentile":318120.8,"90th_percentile":318120.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":55848.63,"10th_percentile":55848.63,"90th_percentile":55848.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","code_information":[{"code":"455","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31276.31,"10th_percentile":31276.31,"90th_percentile":31276.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44437.38,"10th_percentile":44437.38,"90th_percentile":44437.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"1 through 10","median_amount":12271.99,"10th_percentile":12271.99,"90th_percentile":12271.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"459","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":222242.33,"10th_percentile":222242.33,"90th_percentile":222242.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"460","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","code_information":[{"code":"484","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","code_information":[{"code":"490","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w/o CC/MCC","code_information":[{"code":"491","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","code_information":[{"code":"523","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient ischemia","code_information":[{"code":"524","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other heart assist system implant","code_information":[{"code":"525","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"526","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"527","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Proc w Pdx Hemorrhage","code_information":[{"code":"528","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular shunt procedures w CC","code_information":[{"code":"529","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures w/o CC","code_information":[{"code":"530","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w CC","code_information":[{"code":"531","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w/o CC","code_information":[{"code":"532","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","code_information":[{"code":"567","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","code_information":[{"code":"568","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small & Large Bowel Procedures w CC w Major Gi Dx","code_information":[{"code":"569","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Admit For Renal Dialysis","code_information":[{"code":"685","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W Cc/Mcc","code_information":[{"code":"691","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","code_information":[{"code":"692","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W Cc/Mcc","code_information":[{"code":"765","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W/O Cc/Mcc","code_information":[{"code":"766","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Sterilization &/Or D&C","code_information":[{"code":"767","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Complicating Diagnoses","code_information":[{"code":"774","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W/O Complicating Diagnoses","code_information":[{"code":"775","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ectopic Pregnancy","code_information":[{"code":"777","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Threatened Abortion","code_information":[{"code":"778","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"False Labor","code_information":[{"code":"780","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W Medical Complications","code_information":[{"code":"781","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W/O Medical Complications","code_information":[{"code":"782","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","code_information":[{"code":"984","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","code_information":[{"code":"985","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","code_information":[{"code":"986","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Principal Diagnosis Invalid As Discharge Diagnosis","code_information":[{"code":"998","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ungroupable","code_information":[{"code":"999","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 180898 | Excess % of Charge: 48.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 230000 | Excess % of Charge: 45] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7000 Days: 3 Additional Days: 1500] [Normal vag. Del. 2 day stay-Case Rate: 4250 Days: 2 Additional Days: 1500] [Psych-Case Rate: 4500 Days: 3 Additional Days: 1000] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7798 (%BC): 22.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 250000 | Excess % of Charge: 30] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 10000 Days: 3 Additional Days: 1800] [Normal vag. Del. 2 day stay-Case Rate: 7000 Days: 2 Additional Days: 1800] [Normal Newborn-Per Diem: 1500] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3150] [Severe Level Neonate-per diem: 3150] [Psych-Case Rate: 6050 Days: 3 Additional Days: 1500] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 7800 (%BC): 25]","count":"1 through 10","median_amount":44456.12,"10th_percentile":44456.12,"90th_percentile":44456.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 116699 | Total % of Charge: 65] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1500 (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 209174 | Total % of Charge: 7664] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 4571] [Surgical-Per Diem: 4571] [ICU-Per Diem: 5731] [CCU-Per Diem: 5731] [Step Down-Per Diem: 4746] [C-Section 3 day stay-Case Rate: 8981 Days: 3 Additional Days: 2010] [Normal vag. Del. 2 day stay-Case Rate: 6417 Days: 2 Additional Days: 2010] [Normal Newborn-Per Diem: 1262] [Lower Level Neonate-Per Diem: 1766] [Higher Level Neonate-Per Diem: 4542] [Severe Level Neonate-per diem: 4542] [Psych-Per Diem: 955] [Rehab-Per Diem: 1922] [Hospice-Per Diem: 1390] [IP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 44] [Bariatric Surgery-Case Rate: 31052]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ketorolac tromethamine inj","code_information":[{"code":"0764","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":196289.27,"10th_percentile":196289.27,"90th_percentile":196289.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, methylpred acetate 1 mg","code_information":[{"code":"0790","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":525.14,"10th_percentile":525.14,"90th_percentile":525.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"1 through 10","median_amount":1234.78,"10th_percentile":1234.78,"90th_percentile":1234.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":2826.16,"10th_percentile":2201.17,"90th_percentile":7492.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pmkr, dual, leadless","code_information":[{"code":"2046","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":65077.1,"10th_percentile":65077.1,"90th_percentile":65077.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cath coronary drug-delivery","code_information":[{"code":"2050","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12569.2,"10th_percentile":12569.2,"90th_percentile":12569.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":121.17,"10th_percentile":96.09,"90th_percentile":160.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"31","median_amount":83.45,"10th_percentile":30.4,"90th_percentile":161.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"54","median_amount":131.65,"10th_percentile":131.65,"90th_percentile":132.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"1 through 10","median_amount":190.0,"10th_percentile":152.0,"90th_percentile":295.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"12","median_amount":117.64,"10th_percentile":93.29,"90th_percentile":152.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"31","median_amount":134.34,"10th_percentile":127.49,"90th_percentile":134.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"138","median_amount":190.0,"10th_percentile":152.0,"90th_percentile":591.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"15","median_amount":56.7,"10th_percentile":53.2,"90th_percentile":105.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"23","median_amount":131.65,"10th_percentile":131.65,"90th_percentile":240.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":125.36,"10th_percentile":117.64,"90th_percentile":152.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":123.52,"10th_percentile":123.52,"90th_percentile":123.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":114.0,"10th_percentile":114.0,"90th_percentile":312.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":132.97,"10th_percentile":132.97,"90th_percentile":133.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"28","median_amount":123.69,"10th_percentile":98.95,"90th_percentile":192.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":112.25,"10th_percentile":112.25,"90th_percentile":112.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":285.48,"10th_percentile":285.48,"90th_percentile":285.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":202.64,"10th_percentile":202.64,"90th_percentile":244.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":300.0,"10th_percentile":300.0,"90th_percentile":300.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":89.95,"10th_percentile":89.95,"90th_percentile":89.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":815.0,"10th_percentile":815.0,"90th_percentile":815.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":182.74,"10th_percentile":152.02,"90th_percentile":214.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":500.4,"10th_percentile":500.4,"90th_percentile":500.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":164.18,"10th_percentile":164.18,"90th_percentile":164.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"1 through 10","median_amount":890.0,"10th_percentile":890.0,"90th_percentile":890.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"31","median_amount":142.49,"10th_percentile":117.2,"90th_percentile":262.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":165.08,"10th_percentile":165.08,"90th_percentile":165.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"16","median_amount":890.0,"10th_percentile":890.0,"90th_percentile":1340.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":493.95,"10th_percentile":434.9,"90th_percentile":724.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":137.13,"10th_percentile":135.07,"90th_percentile":262.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":171.64,"10th_percentile":171.64,"90th_percentile":171.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":163.4,"10th_percentile":163.4,"90th_percentile":163.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":890.0,"10th_percentile":890.0,"90th_percentile":890.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"16","median_amount":274.08,"10th_percentile":151.7,"90th_percentile":452.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"12","median_amount":958.83,"10th_percentile":754.85,"90th_percentile":1146.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":284.87,"10th_percentile":282.87,"90th_percentile":285.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"13","median_amount":2102.67,"10th_percentile":1963.0,"90th_percentile":2602.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"103","median_amount":208.19,"10th_percentile":135.07,"90th_percentile":515.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":292.57,"10th_percentile":288.64,"90th_percentile":409.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"55","median_amount":2123.0,"10th_percentile":1559.79,"90th_percentile":3100.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"20","median_amount":915.9,"10th_percentile":725.96,"90th_percentile":1470.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":161.78,"10th_percentile":161.78,"90th_percentile":161.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"38","median_amount":208.19,"10th_percentile":137.13,"90th_percentile":515.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":230.17,"10th_percentile":155.43,"90th_percentile":673.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":404.81,"10th_percentile":404.81,"90th_percentile":404.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":285.7,"10th_percentile":285.7,"90th_percentile":288.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"14","median_amount":2131.0,"10th_percentile":1554.6,"90th_percentile":2685.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"30","median_amount":508.28,"10th_percentile":172.86,"90th_percentile":892.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":980.39,"10th_percentile":980.39,"90th_percentile":980.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"28","median_amount":2085.87,"10th_percentile":1722.96,"90th_percentile":2947.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"22","median_amount":546.43,"10th_percentile":437.4,"90th_percentile":666.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"23","median_amount":6546.58,"10th_percentile":4672.33,"90th_percentile":9058.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"100","median_amount":376.02,"10th_percentile":148.03,"90th_percentile":790.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":677.96,"10th_percentile":443.88,"90th_percentile":897.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"181","median_amount":5416.37,"10th_percentile":3735.0,"90th_percentile":8730.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"27","median_amount":2407.07,"10th_percentile":1109.5,"90th_percentile":4069.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":667.11,"10th_percentile":545.86,"90th_percentile":930.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"45","median_amount":376.02,"10th_percentile":137.13,"90th_percentile":775.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":1022.84,"10th_percentile":1022.84,"90th_percentile":1022.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":448.7,"10th_percentile":436.66,"90th_percentile":856.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":442.27,"10th_percentile":442.27,"90th_percentile":644.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":672.06,"10th_percentile":535.12,"90th_percentile":891.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"30","median_amount":2685.0,"10th_percentile":1505.98,"90th_percentile":5053.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":369.91,"10th_percentile":369.91,"90th_percentile":369.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"35","median_amount":620.12,"10th_percentile":172.86,"90th_percentile":1554.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1705.06,"10th_percentile":1705.06,"90th_percentile":1705.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"33","median_amount":3077.29,"10th_percentile":716.28,"90th_percentile":6106.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"47","median_amount":1255.34,"10th_percentile":125.0,"90th_percentile":2893.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"20","median_amount":11356.35,"10th_percentile":6456.9,"90th_percentile":15704.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"128","median_amount":329.43,"10th_percentile":146.66,"90th_percentile":1027.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":1333.25,"10th_percentile":841.75,"90th_percentile":2864.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"183","median_amount":10437.8,"10th_percentile":5845.0,"90th_percentile":19098.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"21","median_amount":3976.43,"10th_percentile":1915.9,"90th_percentile":6995.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":504.3,"10th_percentile":504.3,"90th_percentile":504.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"20","median_amount":1017.87,"10th_percentile":650.24,"90th_percentile":2974.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9940.0,"10th_percentile":9940.0,"90th_percentile":9940.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"50","median_amount":411.64,"10th_percentile":148.03,"90th_percentile":946.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":2505.04,"10th_percentile":2505.04,"90th_percentile":2505.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"16","median_amount":432.22,"10th_percentile":176.22,"90th_percentile":1205.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":607.15,"10th_percentile":607.15,"90th_percentile":607.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2731.9,"10th_percentile":943.35,"90th_percentile":2940.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"34","median_amount":3475.31,"10th_percentile":2362.93,"90th_percentile":4811.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":184.79,"10th_percentile":184.79,"90th_percentile":185.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":9555.78,"10th_percentile":9555.78,"90th_percentile":9555.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2723.77,"10th_percentile":2723.77,"90th_percentile":2723.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"1 through 10","median_amount":17576.0,"10th_percentile":17576.0,"90th_percentile":17576.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":351.6,"10th_percentile":202.46,"90th_percentile":1554.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":14180.19,"10th_percentile":13278.38,"90th_percentile":19032.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":2114.0,"10th_percentile":2114.0,"90th_percentile":2114.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2844.22,"10th_percentile":2844.22,"90th_percentile":2844.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":737.64,"10th_percentile":737.64,"90th_percentile":737.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":146.4,"10th_percentile":146.4,"90th_percentile":146.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2915.75,"10th_percentile":2915.75,"90th_percentile":2915.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":6833.42,"10th_percentile":6833.42,"90th_percentile":6833.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":236.46,"10th_percentile":236.46,"90th_percentile":236.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":1409.47,"10th_percentile":1409.47,"90th_percentile":1409.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":361.44,"10th_percentile":361.44,"90th_percentile":361.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Skin Procedures","code_information":[{"code":"5055","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":22866.68,"10th_percentile":22866.68,"90th_percentile":22866.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1188.25,"10th_percentile":1188.25,"90th_percentile":1188.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1089.0,"10th_percentile":1089.0,"90th_percentile":3217.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":526.1,"10th_percentile":526.1,"90th_percentile":592.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":733.44,"10th_percentile":733.44,"90th_percentile":733.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"13","median_amount":3225.0,"10th_percentile":2638.69,"90th_percentile":4738.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":2749.34,"10th_percentile":1308.54,"90th_percentile":3690.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1153.64,"10th_percentile":1153.64,"90th_percentile":1153.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":730.86,"10th_percentile":730.86,"90th_percentile":730.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1188.25,"10th_percentile":1188.25,"90th_percentile":1188.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":639.06,"10th_percentile":639.06,"90th_percentile":639.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1997.17,"10th_percentile":576.01,"90th_percentile":3217.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1662.19,"10th_percentile":1662.19,"90th_percentile":1662.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1153.64,"10th_percentile":1048.77,"90th_percentile":1153.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1688.97,"10th_percentile":1688.97,"90th_percentile":1688.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"30","median_amount":3851.44,"10th_percentile":350.0,"90th_percentile":8504.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":1107.23,"10th_percentile":968.1,"90th_percentile":1856.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1663.19,"10th_percentile":1663.19,"90th_percentile":1663.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1153.64,"10th_percentile":1153.64,"90th_percentile":1153.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":2533.46,"10th_percentile":2533.46,"90th_percentile":2533.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1676.75,"10th_percentile":1676.75,"90th_percentile":1676.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":3205.0,"10th_percentile":3205.0,"90th_percentile":3205.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2927.64,"10th_percentile":2927.64,"90th_percentile":2927.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1048.77,"10th_percentile":1048.77,"90th_percentile":1048.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2983.46,"10th_percentile":2983.46,"90th_percentile":2983.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":15150.96,"10th_percentile":13274.96,"90th_percentile":16281.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":3205.0,"10th_percentile":3205.0,"90th_percentile":3205.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5091","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5111.04,"10th_percentile":5111.04,"90th_percentile":5111.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6669.84,"10th_percentile":6669.84,"90th_percentile":6669.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2645.84,"10th_percentile":2645.84,"90th_percentile":2645.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3810.52,"10th_percentile":3810.52,"90th_percentile":3991.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":23934.96,"10th_percentile":23934.96,"90th_percentile":43826.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":2840.41,"10th_percentile":2840.41,"90th_percentile":2840.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3966.98,"10th_percentile":3966.98,"90th_percentile":3966.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5092","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6263.62,"10th_percentile":6263.62,"90th_percentile":6263.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":25635.15,"10th_percentile":25635.15,"90th_percentile":29106.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":18185.66,"10th_percentile":18185.66,"90th_percentile":18185.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":14113.27,"10th_percentile":14113.27,"90th_percentile":14113.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5093","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":49428.37,"10th_percentile":49428.37,"90th_percentile":49428.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5094","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":11147.5,"10th_percentile":11147.5,"90th_percentile":11147.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17780.96,"10th_percentile":17780.96,"90th_percentile":17780.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"1 through 10","median_amount":173017.39,"10th_percentile":173017.39,"90th_percentile":173017.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":172221.9,"10th_percentile":172221.9,"90th_percentile":176012.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1637.43,"10th_percentile":1637.43,"90th_percentile":1637.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":730.98,"10th_percentile":730.98,"90th_percentile":730.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":842.37,"10th_percentile":842.37,"90th_percentile":842.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1651.29,"10th_percentile":1651.29,"90th_percentile":1651.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Musculoskeletal Procedures","code_information":[{"code":"5113","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"1 through 10","median_amount":5232.91,"10th_percentile":5232.91,"90th_percentile":5232.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2218.06,"10th_percentile":2218.06,"90th_percentile":2218.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"1 through 10","median_amount":33572.14,"10th_percentile":33572.14,"90th_percentile":33572.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":262.21,"10th_percentile":262.21,"90th_percentile":262.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7446.77,"10th_percentile":7446.77,"90th_percentile":7446.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":41338.45,"10th_percentile":32181.69,"90th_percentile":60693.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":10740.99,"10th_percentile":10740.99,"90th_percentile":10740.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7486.62,"10th_percentile":7486.62,"90th_percentile":7486.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7370.82,"10th_percentile":7370.82,"90th_percentile":7370.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":18727.95,"10th_percentile":18727.95,"90th_percentile":18727.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13420.49,"10th_percentile":13420.49,"90th_percentile":13420.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":215996.61,"10th_percentile":215996.61,"90th_percentile":215996.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13280.53,"10th_percentile":13280.53,"90th_percentile":13280.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":18190.47,"10th_percentile":18190.47,"90th_percentile":18190.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Musculoskeletal Procedures","code_information":[{"code":"5116","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":194856.42,"10th_percentile":194856.42,"90th_percentile":314090.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Airway Endoscopy","code_information":[{"code":"5153","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":785.32,"10th_percentile":785.32,"90th_percentile":785.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Airway Endoscopy","code_information":[{"code":"5155","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7071.8,"10th_percentile":7071.8,"90th_percentile":7071.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"1 through 10","median_amount":74436.96,"10th_percentile":74436.96,"90th_percentile":74436.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":65239.92,"10th_percentile":65239.92,"90th_percentile":65239.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4719.27,"10th_percentile":4719.27,"90th_percentile":4719.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":10824.18,"10th_percentile":10824.18,"90th_percentile":10824.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5550.36,"10th_percentile":5550.36,"90th_percentile":5550.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 ENT Procedures","code_information":[{"code":"5163","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1249.38,"10th_percentile":1249.38,"90th_percentile":1249.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1819.49,"10th_percentile":1819.49,"90th_percentile":1819.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":13618.59,"10th_percentile":13618.59,"90th_percentile":13618.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":10061.64,"10th_percentile":10061.64,"90th_percentile":10061.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1819.49,"10th_percentile":1819.49,"90th_percentile":1819.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 ENT Procedures","code_information":[{"code":"5164","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1772.79,"10th_percentile":1772.79,"90th_percentile":1772.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1721.16,"10th_percentile":1721.16,"90th_percentile":2630.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":20186.97,"10th_percentile":20186.97,"90th_percentile":20186.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":7750.4,"10th_percentile":7750.4,"90th_percentile":7750.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1212.99,"10th_percentile":1212.99,"90th_percentile":1212.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4261.36,"10th_percentile":4261.36,"90th_percentile":4261.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 ENT Procedures","code_information":[{"code":"5165","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2709.82,"10th_percentile":2709.82,"90th_percentile":2709.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"1 through 10","median_amount":88148.96,"10th_percentile":88148.96,"90th_percentile":88148.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1721.16,"10th_percentile":1721.16,"90th_percentile":4499.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3384.57,"10th_percentile":3384.57,"90th_percentile":3384.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":26331.46,"10th_percentile":24701.84,"90th_percentile":32222.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":8470.85,"10th_percentile":8470.85,"90th_percentile":10173.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1721.16,"10th_percentile":1721.16,"90th_percentile":1721.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":7419.0,"10th_percentile":7419.0,"90th_percentile":7419.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Vascular Procedures","code_information":[{"code":"5181","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":9332.52,"10th_percentile":9332.52,"90th_percentile":9332.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":382.94,"10th_percentile":382.94,"90th_percentile":382.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":889.86,"10th_percentile":889.86,"90th_percentile":889.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":2414.0,"10th_percentile":2414.0,"90th_percentile":2414.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":4215.56,"10th_percentile":4215.56,"90th_percentile":4215.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1709.8,"10th_percentile":1709.8,"90th_percentile":1709.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3224.25,"10th_percentile":3224.25,"90th_percentile":3224.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4073.23,"10th_percentile":4073.23,"90th_percentile":4073.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3284.95,"10th_percentile":3284.95,"90th_percentile":3284.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":12614.92,"10th_percentile":12614.92,"90th_percentile":12614.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1837.55,"10th_percentile":1837.55,"90th_percentile":1837.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Vascular Procedures","code_information":[{"code":"5184","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":8709.8,"10th_percentile":8709.8,"90th_percentile":8709.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3051.23,"10th_percentile":3051.23,"90th_percentile":3051.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":22043.57,"10th_percentile":22043.57,"90th_percentile":22043.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5749.45,"10th_percentile":5749.45,"90th_percentile":5749.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Endovascular Procedures","code_information":[{"code":"5191","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3290.79,"10th_percentile":3285.79,"90th_percentile":3296.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"1 through 10","median_amount":11683.61,"10th_percentile":11683.61,"90th_percentile":11683.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2092.0,"10th_percentile":2092.0,"90th_percentile":2092.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3352.85,"10th_percentile":3352.85,"90th_percentile":3352.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"15","median_amount":16480.9,"10th_percentile":11774.19,"90th_percentile":25287.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":5843.38,"10th_percentile":5843.38,"90th_percentile":5843.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3293.79,"10th_percentile":3293.79,"90th_percentile":3293.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2092.0,"10th_percentile":2092.0,"90th_percentile":2092.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3323.36,"10th_percentile":3319.06,"90th_percentile":3332.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":7998.0,"10th_percentile":7998.0,"90th_percentile":7998.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Endovascular Procedures","code_information":[{"code":"5192","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":71417.32,"10th_percentile":71417.32,"90th_percentile":71417.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Endovascular Procedures","code_information":[{"code":"5193","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11603.15,"10th_percentile":11603.15,"90th_percentile":11603.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":46275.9,"10th_percentile":31801.87,"90th_percentile":60464.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18355.92,"10th_percentile":18355.92,"90th_percentile":18355.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9276.05,"10th_percentile":9276.05,"90th_percentile":9276.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Endovascular Procedures","code_information":[{"code":"5194","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7079.34,"10th_percentile":7079.34,"90th_percentile":7079.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18351.57,"10th_percentile":18351.57,"90th_percentile":18351.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17763.8,"10th_percentile":17763.8,"90th_percentile":17763.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":105865.27,"10th_percentile":105865.27,"90th_percentile":105865.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Implantation Wireless PA Pressure Monitor","code_information":[{"code":"5200","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":29049.07,"10th_percentile":29049.07,"90th_percentile":29049.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Electrophysiologic Procedures","code_information":[{"code":"5212","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":47284.0,"10th_percentile":47284.0,"90th_percentile":47284.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Electrophysiologic Procedures","code_information":[{"code":"5213","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":25061.5,"10th_percentile":25061.5,"90th_percentile":25065.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":24268.74,"10th_percentile":24268.74,"90th_percentile":24268.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":25572.96,"10th_percentile":25572.96,"90th_percentile":25572.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"14","median_amount":146889.8,"10th_percentile":112681.14,"90th_percentile":182810.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":21634.07,"10th_percentile":21634.07,"90th_percentile":21634.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":25069.5,"10th_percentile":25069.5,"90th_percentile":25069.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":15156.12,"10th_percentile":15156.12,"90th_percentile":15156.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":25320.32,"10th_percentile":25320.32,"90th_percentile":25320.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":6996.0,"10th_percentile":6996.0,"90th_percentile":6996.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pacemaker and Similar Procedures","code_information":[{"code":"5222","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8627.05,"10th_percentile":8627.05,"90th_percentile":8627.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":40865.27,"10th_percentile":40865.27,"90th_percentile":40865.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8462.51,"10th_percentile":8462.51,"90th_percentile":8462.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":41131.08,"10th_percentile":41131.08,"90th_percentile":41131.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pacemaker and Similar Procedures","code_information":[{"code":"5223","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":549.6,"10th_percentile":549.6,"90th_percentile":549.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10698.08,"10th_percentile":10698.08,"90th_percentile":10698.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10909.27,"10th_percentile":10909.27,"90th_percentile":10909.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10697.08,"10th_percentile":10697.08,"90th_percentile":10697.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10805.5,"10th_percentile":10805.5,"90th_percentile":10805.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 ICD and Similar Procedures","code_information":[{"code":"5231","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":107763.35,"10th_percentile":107763.35,"90th_percentile":107763.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":23167.6,"10th_percentile":23167.6,"90th_percentile":23167.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 ICD and Similar Procedures","code_information":[{"code":"5232","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"1 through 10","median_amount":118102.42,"10th_percentile":118102.42,"90th_percentile":118102.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":33421.63,"10th_percentile":33421.63,"90th_percentile":33421.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":120405.0,"10th_percentile":120405.0,"90th_percentile":120405.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":47.52,"10th_percentile":47.52,"90th_percentile":47.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":880.24,"10th_percentile":880.24,"90th_percentile":880.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":3116.73,"10th_percentile":3104.69,"90th_percentile":4837.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"17","median_amount":966.63,"10th_percentile":957.78,"90th_percentile":2882.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":836.35,"10th_percentile":836.35,"90th_percentile":854.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":977.33,"10th_percentile":977.33,"90th_percentile":1836.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"28","median_amount":6040.04,"10th_percentile":4147.24,"90th_percentile":13543.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":2445.12,"10th_percentile":2235.96,"90th_percentile":3378.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":965.78,"10th_percentile":965.78,"90th_percentile":1423.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":836.35,"10th_percentile":789.09,"90th_percentile":1130.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":974.86,"10th_percentile":974.86,"90th_percentile":974.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":3205.0,"10th_percentile":3205.0,"90th_percentile":4807.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":880.24,"10th_percentile":880.24,"90th_percentile":880.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":6446.14,"10th_percentile":6446.14,"90th_percentile":6446.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1943.54,"10th_percentile":1940.41,"90th_percentile":1949.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2255.59,"10th_percentile":1977.46,"90th_percentile":3965.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"18","median_amount":6639.57,"10th_percentile":3537.04,"90th_percentile":11033.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1943.91,"10th_percentile":1943.91,"90th_percentile":1943.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3936.87,"10th_percentile":3936.87,"90th_percentile":3936.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Upper GI Procedures","code_information":[{"code":"5303","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":57760.46,"10th_percentile":57760.46,"90th_percentile":57760.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3902.46,"10th_percentile":3902.46,"90th_percentile":3902.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":880.24,"10th_percentile":880.24,"90th_percentile":880.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1086.8,"10th_percentile":1032.87,"90th_percentile":3234.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":931.37,"10th_percentile":931.37,"90th_percentile":931.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":854.6,"10th_percentile":854.6,"90th_percentile":854.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":954.31,"10th_percentile":954.31,"90th_percentile":954.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"34","median_amount":5215.67,"10th_percentile":4802.04,"90th_percentile":6249.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":3001.77,"10th_percentile":3001.77,"90th_percentile":3001.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":931.37,"10th_percentile":931.37,"90th_percentile":931.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":854.6,"10th_percentile":854.6,"90th_percentile":854.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":902.86,"10th_percentile":902.86,"90th_percentile":902.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":940.69,"10th_percentile":940.69,"90th_percentile":940.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":3205.0,"10th_percentile":3205.0,"90th_percentile":3205.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1067.15,"10th_percentile":1067.15,"90th_percentile":1067.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"16","median_amount":2319.71,"10th_percentile":1228.47,"90th_percentile":4841.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"30","median_amount":1208.37,"10th_percentile":1204.52,"90th_percentile":2286.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":854.6,"10th_percentile":854.6,"90th_percentile":854.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"18","median_amount":1717.77,"10th_percentile":1229.1,"90th_percentile":2286.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"80","median_amount":6802.03,"10th_percentile":5632.04,"90th_percentile":9635.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":2605.71,"10th_percentile":2240.93,"90th_percentile":3911.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":1683.42,"10th_percentile":1204.52,"90th_percentile":1806.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":854.6,"10th_percentile":854.6,"90th_percentile":1633.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":2582.56,"10th_percentile":2582.56,"90th_percentile":2582.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":897.33,"10th_percentile":897.33,"90th_percentile":897.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"13","median_amount":1220.25,"10th_percentile":1216.57,"90th_percentile":2308.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"13","median_amount":3205.0,"10th_percentile":3205.0,"90th_percentile":5608.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Lower GI Procedures","code_information":[{"code":"5313","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2801.55,"10th_percentile":2801.55,"90th_percentile":2801.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":16430.94,"10th_percentile":9058.08,"90th_percentile":21748.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":7596.0,"10th_percentile":7596.0,"90th_percentile":7596.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2837.07,"10th_percentile":2837.07,"90th_percentile":2837.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex GI Procedures","code_information":[{"code":"5331","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6081.22,"10th_percentile":6081.22,"90th_percentile":6081.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5341","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":5606.54,"10th_percentile":5606.54,"90th_percentile":5606.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":19589.27,"10th_percentile":19589.27,"90th_percentile":32050.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5342","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":8296.41,"10th_percentile":8296.41,"90th_percentile":8296.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":43307.04,"10th_percentile":43307.04,"90th_percentile":43307.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":4530.0,"10th_percentile":4530.0,"90th_percentile":4530.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":4750.0,"10th_percentile":4750.0,"90th_percentile":11354.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5969.06,"10th_percentile":5969.06,"90th_percentile":5969.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"1 through 10","median_amount":31215.23,"10th_percentile":31215.23,"90th_percentile":31215.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3360.73,"10th_percentile":3360.73,"90th_percentile":3360.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6081.85,"10th_percentile":6081.85,"90th_percentile":6081.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"36","median_amount":33858.07,"10th_percentile":23287.22,"90th_percentile":49371.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":11000.0,"10th_percentile":10684.7,"90th_percentile":11000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4530.82,"10th_percentile":4530.82,"90th_percentile":5904.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5782.23,"10th_percentile":5782.23,"90th_percentile":5782.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6023.72,"10th_percentile":6023.72,"90th_percentile":6023.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":7419.0,"10th_percentile":5939.0,"90th_percentile":9121.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Laparoscopy and Related Services","code_information":[{"code":"5362","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6086.17,"10th_percentile":6086.17,"90th_percentile":6086.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12051.38,"10th_percentile":12051.38,"90th_percentile":12051.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":6356.51,"10th_percentile":6356.51,"90th_percentile":6356.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"1 through 10","median_amount":57472.05,"10th_percentile":57472.05,"90th_percentile":57472.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1741.6,"10th_percentile":1741.6,"90th_percentile":1741.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":63675.22,"10th_percentile":44541.98,"90th_percentile":81187.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":1829.33,"10th_percentile":1829.33,"90th_percentile":1829.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10785.58,"10th_percentile":10785.58,"90th_percentile":10785.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":5939.0,"10th_percentile":5939.0,"90th_percentile":5939.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Urology and Related Services","code_information":[{"code":"5374","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":36893.77,"10th_percentile":36893.77,"90th_percentile":36893.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3558.91,"10th_percentile":3558.91,"90th_percentile":3558.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Urology and Related Services","code_information":[{"code":"5375","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"1 through 10","median_amount":34628.6,"10th_percentile":34628.6,"90th_percentile":34628.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":32609.6,"10th_percentile":32609.6,"90th_percentile":32609.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dialysis","code_information":[{"code":"5401","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2759.72,"10th_percentile":2759.72,"90th_percentile":2759.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Gynecologic Procedures","code_information":[{"code":"5411","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":172.86,"10th_percentile":172.86,"90th_percentile":172.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":503.87,"10th_percentile":503.87,"90th_percentile":503.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"1 through 10","median_amount":2225.0,"10th_percentile":2225.0,"90th_percentile":2225.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"18","median_amount":167.83,"10th_percentile":167.83,"90th_percentile":167.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"18","median_amount":1575.0,"10th_percentile":1575.0,"90th_percentile":3270.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":694.83,"10th_percentile":694.83,"90th_percentile":694.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":167.83,"10th_percentile":167.83,"90th_percentile":167.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":327.4,"10th_percentile":327.4,"90th_percentile":327.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":1112.23,"10th_percentile":1112.23,"90th_percentile":1112.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Gynecologic Procedures","code_information":[{"code":"5412","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":19198.9,"10th_percentile":19198.9,"90th_percentile":19198.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":152.7,"10th_percentile":152.7,"90th_percentile":152.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Gynecologic Procedures","code_information":[{"code":"5414","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2075.93,"10th_percentile":2075.93,"90th_percentile":2075.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"1 through 10","median_amount":19489.92,"10th_percentile":19489.92,"90th_percentile":32613.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1499.52,"10th_percentile":1499.52,"90th_percentile":2413.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"18","median_amount":21259.04,"10th_percentile":14713.62,"90th_percentile":24812.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":8719.67,"10th_percentile":8719.67,"90th_percentile":8719.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1468.76,"10th_percentile":1468.76,"90th_percentile":1468.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2116.24,"10th_percentile":2116.24,"90th_percentile":2116.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3280.6,"10th_percentile":3280.6,"90th_percentile":3280.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":3671.0,"10th_percentile":3671.0,"90th_percentile":3671.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Gynecologic Procedures","code_information":[{"code":"5415","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3676.37,"10th_percentile":3676.37,"90th_percentile":3676.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1.34,"10th_percentile":1.34,"90th_percentile":1.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5046.24,"10th_percentile":5046.24,"90th_percentile":5046.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2015.47,"10th_percentile":2015.47,"90th_percentile":2015.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":529.17,"10th_percentile":529.17,"90th_percentile":32472.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":11000.0,"10th_percentile":11000.0,"90th_percentile":11000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2015.47,"10th_percentile":2015.47,"90th_percentile":2015.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Gynecologic Procedures","code_information":[{"code":"5416","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7561.83,"10th_percentile":7561.83,"90th_percentile":7561.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":35470.46,"10th_percentile":35470.46,"90th_percentile":35470.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":12836.32,"10th_percentile":12836.32,"90th_percentile":12836.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Procedures","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":3253.09,"10th_percentile":2581.29,"90th_percentile":3644.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1998.75,"10th_percentile":1994.9,"90th_percentile":2001.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"1 through 10","median_amount":11103.15,"10th_percentile":11010.66,"90th_percentile":16315.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1167.59,"10th_percentile":1167.59,"90th_percentile":1167.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2035.61,"10th_percentile":2035.61,"90th_percentile":2051.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"35","median_amount":10941.87,"10th_percentile":9310.01,"90th_percentile":16654.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":4496.57,"10th_percentile":3726.14,"90th_percentile":4562.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1997.9,"10th_percentile":1997.9,"90th_percentile":1997.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2015.36,"10th_percentile":2015.36,"90th_percentile":2015.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":4231.0,"10th_percentile":4231.0,"90th_percentile":4231.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Injections","code_information":[{"code":"5441","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":13.38,"10th_percentile":13.38,"90th_percentile":13.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":310.89,"10th_percentile":310.89,"90th_percentile":314.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"1 through 10","median_amount":2633.27,"10th_percentile":2633.27,"90th_percentile":2633.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":450.79,"10th_percentile":321.99,"90th_percentile":471.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"13","median_amount":2793.91,"10th_percentile":2639.65,"90th_percentile":4084.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":310.89,"10th_percentile":310.89,"90th_percentile":464.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":314.01,"10th_percentile":314.01,"90th_percentile":314.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":1120.0,"10th_percentile":1120.0,"90th_percentile":1120.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":2446.12,"10th_percentile":2446.12,"90th_percentile":2446.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":707.46,"10th_percentile":707.46,"90th_percentile":723.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"1 through 10","median_amount":4610.24,"10th_percentile":4465.04,"90th_percentile":4651.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1085.45,"10th_percentile":1085.45,"90th_percentile":1085.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":721.9,"10th_percentile":721.9,"90th_percentile":721.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"20","median_amount":4493.53,"10th_percentile":3186.0,"90th_percentile":7479.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":710.35,"10th_percentile":710.35,"90th_percentile":723.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":871.56,"10th_percentile":871.56,"90th_percentile":871.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":2396.0,"10th_percentile":2396.0,"90th_percentile":2396.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Nerve Injections","code_information":[{"code":"5443","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1544.82,"10th_percentile":928.53,"90th_percentile":6048.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1364.24,"10th_percentile":913.35,"90th_percentile":1381.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"16","median_amount":7028.64,"10th_percentile":5400.31,"90th_percentile":8373.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":928.06,"10th_percentile":928.06,"90th_percentile":1406.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"45","median_amount":5781.7,"10th_percentile":4250.11,"90th_percentile":8319.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":2934.87,"10th_percentile":2800.51,"90th_percentile":4009.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1376.1,"10th_percentile":931.49,"90th_percentile":1381.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":881.66,"10th_percentile":881.66,"90th_percentile":881.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1387.36,"10th_percentile":1387.36,"90th_percentile":1849.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":2956.0,"10th_percentile":2956.0,"90th_percentile":3874.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Neurostimulator and Related Procedures","code_information":[{"code":"5462","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6708.32,"10th_percentile":6708.32,"90th_percentile":6711.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":400.0,"10th_percentile":400.0,"90th_percentile":400.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Neurostimulator and Related Procedures","code_information":[{"code":"5465","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":31137.95,"10th_percentile":31137.95,"90th_percentile":31137.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":63429.08,"10th_percentile":63429.08,"90th_percentile":63429.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Extraocular, Repair, and Plastic Eye Procedures","code_information":[{"code":"5501","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":250.53,"10th_percentile":250.53,"90th_percentile":250.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Extraocular, Repair, and Plastic Eye Procedures","code_information":[{"code":"5503","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2390.28,"10th_percentile":2390.28,"90th_percentile":2390.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1486.26,"10th_percentile":1486.26,"90th_percentile":1486.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2754.55,"10th_percentile":2754.55,"90th_percentile":2754.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Extraocular, Repair, and Plastic Eye Procedures","code_information":[{"code":"5504","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1836.37,"10th_percentile":1836.37,"90th_percentile":1836.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"12","median_amount":50.16,"10th_percentile":50.16,"90th_percentile":161.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"52","median_amount":236.67,"10th_percentile":100.0,"90th_percentile":885.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"37","median_amount":90.23,"10th_percentile":89.95,"90th_percentile":217.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"1 through 10","median_amount":550.0,"10th_percentile":550.0,"90th_percentile":1675.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"44","median_amount":94.78,"10th_percentile":48.7,"90th_percentile":156.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"19","median_amount":91.79,"10th_percentile":91.79,"90th_percentile":221.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"219","median_amount":600.0,"10th_percentile":450.0,"90th_percentile":1532.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"34","median_amount":376.25,"10th_percentile":192.5,"90th_percentile":540.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":48.7,"10th_percentile":48.7,"90th_percentile":48.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":91.79,"10th_percentile":90.32,"90th_percentile":195.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"22","median_amount":73.05,"10th_percentile":48.7,"90th_percentile":156.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":137.69,"10th_percentile":137.69,"90th_percentile":295.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":164.75,"10th_percentile":164.75,"90th_percentile":164.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":87.2,"10th_percentile":87.2,"90th_percentile":87.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"18","median_amount":91.36,"10th_percentile":90.86,"90th_percentile":219.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"44","median_amount":800.28,"10th_percentile":500.0,"90th_percentile":1223.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"47","median_amount":97.62,"10th_percentile":75.24,"90th_percentile":200.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":121.07,"10th_percentile":121.07,"90th_percentile":121.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"99","median_amount":280.0,"10th_percentile":118.77,"90th_percentile":680.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"110","median_amount":108.83,"10th_percentile":108.63,"90th_percentile":224.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"11","median_amount":1450.0,"10th_percentile":1300.0,"90th_percentile":2550.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"124","median_amount":130.5,"10th_percentile":73.05,"90th_percentile":240.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"43","median_amount":110.85,"10th_percentile":110.85,"90th_percentile":229.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"475","median_amount":1370.0,"10th_percentile":510.0,"90th_percentile":2550.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"57","median_amount":519.4,"10th_percentile":274.4,"90th_percentile":999.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"34","median_amount":110.13,"10th_percentile":108.63,"90th_percentile":224.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"40","median_amount":94.78,"10th_percentile":68.38,"90th_percentile":174.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":343.99,"10th_percentile":343.99,"90th_percentile":343.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":91.68,"10th_percentile":91.68,"90th_percentile":151.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":105.31,"10th_percentile":105.31,"90th_percentile":228.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"36","median_amount":110.23,"10th_percentile":109.73,"90th_percentile":226.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"84","median_amount":803.0,"10th_percentile":510.0,"90th_percentile":1210.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"15","median_amount":150.41,"10th_percentile":89.93,"90th_percentile":303.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":275.21,"10th_percentile":275.21,"90th_percentile":275.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"35","median_amount":760.0,"10th_percentile":400.0,"90th_percentile":1814.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"35","median_amount":248.43,"10th_percentile":246.93,"90th_percentile":493.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"1 through 10","median_amount":2450.0,"10th_percentile":1500.0,"90th_percentile":4150.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"41","median_amount":174.61,"10th_percentile":87.31,"90th_percentile":209.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"16","median_amount":251.97,"10th_percentile":239.12,"90th_percentile":534.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"183","median_amount":3800.0,"10th_percentile":1500.0,"90th_percentile":7600.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"22","median_amount":588.0,"10th_percentile":353.27,"90th_percentile":1330.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":247.13,"10th_percentile":246.93,"90th_percentile":251.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"15","median_amount":209.24,"10th_percentile":87.31,"90th_percentile":209.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":377.96,"10th_percentile":377.96,"90th_percentile":377.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":91.68,"10th_percentile":91.68,"90th_percentile":91.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":239.37,"10th_percentile":239.37,"90th_percentile":239.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"13","median_amount":252.41,"10th_percentile":249.41,"90th_percentile":560.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"29","median_amount":1302.0,"10th_percentile":803.0,"90th_percentile":2148.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":386.79,"10th_percentile":386.79,"90th_percentile":469.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":624.28,"10th_percentile":624.28,"90th_percentile":624.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"25","median_amount":1756.8,"10th_percentile":640.0,"90th_percentile":1756.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"46","median_amount":561.84,"10th_percentile":560.13,"90th_percentile":562.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"1 through 10","median_amount":3200.0,"10th_percentile":3200.0,"90th_percentile":4143.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"16","median_amount":375.52,"10th_percentile":375.52,"90th_percentile":470.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"26","median_amount":571.56,"10th_percentile":571.56,"90th_percentile":571.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"111","median_amount":3200.0,"10th_percentile":3200.0,"90th_percentile":6293.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"12","median_amount":1776.0,"10th_percentile":1193.6,"90th_percentile":4329.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":563.13,"10th_percentile":560.13,"90th_percentile":563.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":375.52,"10th_percentile":375.52,"90th_percentile":470.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":568.03,"10th_percentile":566.11,"90th_percentile":570.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"24","median_amount":2350.0,"10th_percentile":2350.0,"90th_percentile":2350.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1539.09,"10th_percentile":552.03,"90th_percentile":4095.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":273.39,"10th_percentile":182.6,"90th_percentile":449.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":263.61,"10th_percentile":263.61,"90th_percentile":328.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":277.84,"10th_percentile":277.84,"90th_percentile":453.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"36","median_amount":3106.7,"10th_percentile":700.0,"90th_percentile":4791.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":1600.0,"10th_percentile":1600.0,"90th_percentile":3152.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":185.57,"10th_percentile":184.86,"90th_percentile":444.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":263.61,"10th_percentile":263.61,"90th_percentile":263.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":448.96,"10th_percentile":275.02,"90th_percentile":453.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":1210.0,"10th_percentile":1210.0,"90th_percentile":2420.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":363.63,"10th_percentile":363.63,"90th_percentile":461.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"14","median_amount":2013.95,"10th_percentile":1157.34,"90th_percentile":2736.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"29","median_amount":366.32,"10th_percentile":364.83,"90th_percentile":454.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"1 through 10","median_amount":1664.21,"10th_percentile":1664.21,"90th_percentile":5617.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":353.04,"10th_percentile":322.09,"90th_percentile":353.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":372.28,"10th_percentile":353.29,"90th_percentile":372.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"129","median_amount":5764.21,"10th_percentile":900.0,"90th_percentile":6406.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":1250.01,"10th_percentile":1250.01,"90th_percentile":1842.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":367.83,"10th_percentile":364.83,"90th_percentile":876.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":353.04,"10th_percentile":353.04,"90th_percentile":602.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":558.42,"10th_percentile":558.42,"90th_percentile":558.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":370.69,"10th_percentile":370.69,"90th_percentile":370.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":353.67,"10th_percentile":353.67,"90th_percentile":353.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":371.48,"10th_percentile":368.48,"90th_percentile":639.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"15","median_amount":1210.0,"10th_percentile":437.2,"90th_percentile":2148.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Imaging with Contrast","code_information":[{"code":"5573","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":836.75,"10th_percentile":836.75,"90th_percentile":836.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":809.1,"10th_percentile":808.6,"90th_percentile":2166.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":823.57,"10th_percentile":823.57,"90th_percentile":823.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":5686.81,"10th_percentile":5686.81,"90th_percentile":5970.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":1120.0,"10th_percentile":1120.0,"90th_percentile":1120.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":810.1,"10th_percentile":810.1,"90th_percentile":810.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":1235.36,"10th_percentile":1235.36,"90th_percentile":1235.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":816.18,"10th_percentile":816.18,"90th_percentile":816.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nuclear Medicine and Related Services","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1129.54,"10th_percentile":1129.54,"90th_percentile":1129.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":414.5,"10th_percentile":414.5,"90th_percentile":414.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":2384.5,"10th_percentile":2207.32,"90th_percentile":4008.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":421.29,"10th_percentile":421.29,"90th_percentile":421.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":628.32,"10th_percentile":628.32,"90th_percentile":628.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":901.12,"10th_percentile":901.12,"90th_percentile":901.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":2651.02,"10th_percentile":2639.09,"90th_percentile":6402.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":748.0,"10th_percentile":748.0,"90th_percentile":748.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Nuclear Medicine and Related Services","code_information":[{"code":"5593","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1797.97,"10th_percentile":1797.97,"90th_percentile":1797.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"13","median_amount":1337.64,"10th_percentile":1333.64,"90th_percentile":2693.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":906.97,"10th_percentile":906.97,"90th_percentile":906.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1360.86,"10th_percentile":324.61,"90th_percentile":1364.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"11","median_amount":9206.17,"10th_percentile":8989.84,"90th_percentile":13378.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":3874.46,"10th_percentile":3874.46,"90th_percentile":4990.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1337.54,"10th_percentile":1337.54,"90th_percentile":2707.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1352.43,"10th_percentile":1352.43,"90th_percentile":2720.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":2147.65,"10th_percentile":2147.65,"90th_percentile":7295.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Nuclear Medicine and Related Services","code_information":[{"code":"5594","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1195.63,"10th_percentile":1195.63,"90th_percentile":1195.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1439.0,"10th_percentile":11.79,"90th_percentile":2733.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":1495.86,"10th_percentile":1490.96,"90th_percentile":6578.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1157.01,"10th_percentile":1157.01,"90th_percentile":1157.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1520.46,"10th_percentile":1442.92,"90th_percentile":1520.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"32","median_amount":7195.0,"10th_percentile":7195.0,"90th_percentile":24485.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":2518.25,"10th_percentile":2518.25,"90th_percentile":3000.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1497.05,"10th_percentile":1493.9,"90th_percentile":1500.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1160.81,"10th_percentile":1160.81,"90th_percentile":1160.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1218.85,"10th_percentile":1218.85,"90th_percentile":1218.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1511.03,"10th_percentile":1509.95,"90th_percentile":1639.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":4631.87,"10th_percentile":4631.87,"90th_percentile":18297.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5611","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":107.32,"10th_percentile":107.32,"90th_percentile":107.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":104.19,"10th_percentile":104.19,"90th_percentile":104.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5612","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":166.58,"10th_percentile":166.58,"90th_percentile":166.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":502.72,"10th_percentile":242.59,"90th_percentile":1165.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":740.31,"10th_percentile":740.31,"90th_percentile":740.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5613","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1200.54,"10th_percentile":1200.54,"90th_percentile":1200.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Radiation Therapy","code_information":[{"code":"5622","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":589.53,"10th_percentile":589.53,"90th_percentile":589.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"16","median_amount":260.13,"10th_percentile":155.94,"90th_percentile":312.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":46355.0,"10th_percentile":46355.0,"90th_percentile":46355.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Radiation Therapy","code_information":[{"code":"5623","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":962.19,"10th_percentile":962.19,"90th_percentile":962.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":8417.34,"10th_percentile":8417.34,"90th_percentile":8417.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"19","median_amount":409.96,"10th_percentile":409.96,"90th_percentile":652.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Radiation Therapy","code_information":[{"code":"5626","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1270.87,"10th_percentile":1270.87,"90th_percentile":1378.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3899.19,"10th_percentile":3899.19,"90th_percentile":3899.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":28.8,"10th_percentile":28.8,"90th_percentile":28.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":83.0,"10th_percentile":24.2,"90th_percentile":205.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":54.59,"10th_percentile":54.59,"90th_percentile":54.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"1 through 10","median_amount":337.0,"10th_percentile":337.0,"90th_percentile":337.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"17","median_amount":27.96,"10th_percentile":27.96,"90th_percentile":72.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":55.7,"10th_percentile":55.7,"90th_percentile":55.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"42","median_amount":216.0,"10th_percentile":108.0,"90th_percentile":421.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":75.6,"10th_percentile":75.6,"90th_percentile":121.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":54.59,"10th_percentile":54.59,"90th_percentile":54.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":27.96,"10th_percentile":27.96,"90th_percentile":41.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":83.55,"10th_percentile":83.55,"90th_percentile":83.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":55.14,"10th_percentile":55.14,"90th_percentile":55.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":32.52,"10th_percentile":32.52,"90th_percentile":32.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":219.46,"10th_percentile":219.46,"90th_percentile":219.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":358.0,"10th_percentile":358.0,"90th_percentile":358.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":175.06,"10th_percentile":175.06,"90th_percentile":175.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":142.05,"10th_percentile":142.05,"90th_percentile":156.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":169.52,"10th_percentile":169.52,"90th_percentile":169.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":587.0,"10th_percentile":479.0,"90th_percentile":1380.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":1006.0,"10th_percentile":1006.0,"90th_percentile":1006.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":137.19,"10th_percentile":137.19,"90th_percentile":137.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":169.7,"10th_percentile":169.7,"90th_percentile":169.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":840.78,"10th_percentile":840.78,"90th_percentile":1315.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":367.48,"10th_percentile":367.48,"90th_percentile":367.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"1 through 10","median_amount":2020.0,"10th_percentile":2020.0,"90th_percentile":2020.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":447.0,"10th_percentile":447.0,"90th_percentile":1614.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":142.25,"10th_percentile":142.25,"90th_percentile":142.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":414.71,"10th_percentile":414.71,"90th_percentile":414.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":179.03,"10th_percentile":179.03,"90th_percentile":179.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":135.6,"10th_percentile":135.6,"90th_percentile":135.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"15","median_amount":617.4,"10th_percentile":360.0,"90th_percentile":988.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":160.49,"10th_percentile":159.84,"90th_percentile":161.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":131.65,"10th_percentile":131.65,"90th_percentile":131.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":163.1,"10th_percentile":154.78,"90th_percentile":163.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"47","median_amount":1800.0,"10th_percentile":1800.0,"90th_percentile":1800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":999.0,"10th_percentile":630.0,"90th_percentile":999.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":159.84,"10th_percentile":159.84,"90th_percentile":159.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":131.65,"10th_percentile":131.65,"90th_percentile":131.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":138.23,"10th_percentile":138.23,"90th_percentile":138.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":162.44,"10th_percentile":162.09,"90th_percentile":162.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":1171.8,"10th_percentile":1171.8,"90th_percentile":1171.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":400.32,"10th_percentile":400.32,"90th_percentile":400.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1180.35,"10th_percentile":706.0,"90th_percentile":1180.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":318.12,"10th_percentile":318.12,"90th_percentile":320.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":388.66,"10th_percentile":388.66,"90th_percentile":388.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":324.61,"10th_percentile":324.61,"90th_percentile":324.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"18","median_amount":2150.0,"10th_percentile":885.0,"90th_percentile":3340.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":519.67,"10th_percentile":519.67,"90th_percentile":519.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":388.66,"10th_percentile":189.37,"90th_percentile":597.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":1399.65,"10th_percentile":576.14,"90th_percentile":1399.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Diagnostic Tests and Related Services","code_information":[{"code":"5723","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":236.81,"10th_percentile":236.81,"90th_percentile":236.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":600.0,"10th_percentile":600.0,"90th_percentile":1588.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":543.71,"10th_percentile":543.71,"90th_percentile":543.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":229.92,"10th_percentile":229.92,"90th_percentile":229.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"11","median_amount":6880.0,"10th_percentile":6370.0,"90th_percentile":7070.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":3818.4,"10th_percentile":3818.4,"90th_percentile":3818.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":172.44,"10th_percentile":172.44,"90th_percentile":172.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":547.47,"10th_percentile":547.47,"90th_percentile":547.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Diagnostic Tests and Related Services","code_information":[{"code":"5724","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":706.02,"10th_percentile":706.02,"90th_percentile":706.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1152.0,"10th_percentile":1152.0,"90th_percentile":3968.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1042.52,"10th_percentile":1039.34,"90th_percentile":1408.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"1 through 10","median_amount":7343.93,"10th_percentile":7343.93,"90th_percentile":7343.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":685.46,"10th_percentile":322.09,"90th_percentile":685.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1359.75,"10th_percentile":1060.55,"90th_percentile":1432.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"34","median_amount":6800.0,"10th_percentile":6800.0,"90th_percentile":7333.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":2544.67,"10th_percentile":2544.67,"90th_percentile":2546.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":371.83,"10th_percentile":371.83,"90th_percentile":371.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":685.46,"10th_percentile":685.46,"90th_percentile":685.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":336.58,"10th_percentile":336.58,"90th_percentile":336.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":373.48,"10th_percentile":373.48,"90th_percentile":373.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":2902.6,"10th_percentile":1682.68,"90th_percentile":4426.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":22.96,"10th_percentile":22.96,"90th_percentile":22.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":67.63,"10th_percentile":67.63,"90th_percentile":67.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":247.05,"10th_percentile":228.4,"90th_percentile":299.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":60.93,"10th_percentile":60.87,"90th_percentile":60.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"1 through 10","median_amount":450.0,"10th_percentile":450.0,"90th_percentile":450.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":26.46,"10th_percentile":22.29,"90th_percentile":41.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":61.92,"10th_percentile":61.92,"90th_percentile":61.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"31","median_amount":450.0,"10th_percentile":450.0,"90th_percentile":851.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":249.75,"10th_percentile":249.75,"90th_percentile":410.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":61.08,"10th_percentile":61.08,"90th_percentile":61.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":28.64,"10th_percentile":28.64,"90th_percentile":28.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":58.82,"10th_percentile":58.82,"90th_percentile":58.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":61.29,"10th_percentile":61.29,"90th_percentile":61.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":321.6,"10th_percentile":292.95,"90th_percentile":343.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":82.75,"10th_percentile":54.47,"90th_percentile":143.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":146.76,"10th_percentile":146.76,"90th_percentile":146.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"19","median_amount":260.0,"10th_percentile":127.6,"90th_percentile":713.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":131.68,"10th_percentile":131.68,"90th_percentile":133.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"39","median_amount":31.55,"10th_percentile":16.32,"90th_percentile":117.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":134.37,"10th_percentile":127.52,"90th_percentile":134.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"74","median_amount":730.0,"10th_percentile":187.0,"90th_percentile":1300.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":405.15,"10th_percentile":185.01,"90th_percentile":966.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":131.68,"10th_percentile":131.68,"90th_percentile":132.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"17","median_amount":76.74,"10th_percentile":45.78,"90th_percentile":134.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":207.97,"10th_percentile":207.97,"90th_percentile":207.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":189.9,"10th_percentile":189.9,"90th_percentile":189.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":133.54,"10th_percentile":133.54,"90th_percentile":135.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"14","median_amount":270.66,"10th_percentile":120.8,"90th_percentile":846.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Minor Procedures","code_information":[{"code":"5735","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":143.17,"10th_percentile":143.17,"90th_percentile":143.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Electronic Analysis of Devices","code_information":[{"code":"5741","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":38.21,"10th_percentile":38.21,"90th_percentile":38.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":36.18,"10th_percentile":36.18,"90th_percentile":36.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":1700.0,"10th_percentile":1700.0,"90th_percentile":1700.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":595.0,"10th_percentile":595.0,"90th_percentile":595.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Electronic Analysis of Devices","code_information":[{"code":"5742","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":104.5,"10th_percentile":104.5,"90th_percentile":104.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":583.1,"10th_percentile":583.1,"90th_percentile":583.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":2700.0,"10th_percentile":2700.0,"90th_percentile":4335.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":1757.7,"10th_percentile":1757.7,"90th_percentile":1757.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Electronic Analysis of Devices","code_information":[{"code":"5743","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":307.63,"10th_percentile":307.63,"90th_percentile":307.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":123.49,"10th_percentile":123.49,"90th_percentile":123.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":493.85,"10th_percentile":493.85,"90th_percentile":493.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":1095.62,"10th_percentile":1095.62,"90th_percentile":1095.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":310.7,"10th_percentile":310.7,"90th_percentile":310.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Resuscitation and Cardioversion","code_information":[{"code":"5781","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1791.23,"10th_percentile":1791.23,"90th_percentile":1791.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":3696.64,"10th_percentile":3633.96,"90th_percentile":9975.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":4148.4,"10th_percentile":4148.4,"90th_percentile":4148.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1245.94,"10th_percentile":1245.94,"90th_percentile":1245.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Health and Behavior Services","code_information":[{"code":"5823","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1864.6,"10th_percentile":1864.6,"90th_percentile":1864.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-OPPS Clinic Services","code_information":[{"code":"N700","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":121.17,"10th_percentile":96.09,"90th_percentile":160.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"25","median_amount":83.45,"10th_percentile":30.4,"90th_percentile":104.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"1 through 10","median_amount":190.0,"10th_percentile":152.0,"90th_percentile":295.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":115.46,"10th_percentile":93.29,"90th_percentile":148.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"115","median_amount":190.0,"10th_percentile":152.0,"90th_percentile":295.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":125.36,"10th_percentile":117.64,"90th_percentile":152.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":123.52,"10th_percentile":123.52,"90th_percentile":123.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"26","median_amount":123.69,"10th_percentile":98.95,"90th_percentile":123.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"263","median_amount":24.34,"10th_percentile":7.63,"90th_percentile":76.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"18","median_amount":42.12,"10th_percentile":11.92,"90th_percentile":115.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"803","median_amount":81.54,"10th_percentile":18.6,"90th_percentile":260.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"810","median_amount":48.84,"10th_percentile":17.2,"90th_percentile":105.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"109","median_amount":199.0,"10th_percentile":46.0,"90th_percentile":494.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1090","median_amount":23.13,"10th_percentile":7.41,"90th_percentile":67.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"404","median_amount":44.95,"10th_percentile":16.66,"90th_percentile":98.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"4274","median_amount":201.0,"10th_percentile":59.0,"90th_percentile":462.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"617","median_amount":99.4,"10th_percentile":23.8,"90th_percentile":354.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5.7,"10th_percentile":5.7,"90th_percentile":5.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"253","median_amount":52.66,"10th_percentile":16.86,"90th_percentile":106.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"398","median_amount":23.6,"10th_percentile":7.41,"90th_percentile":70.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"49","median_amount":106.61,"10th_percentile":33.73,"90th_percentile":249.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"61","median_amount":26.78,"10th_percentile":6.67,"90th_percentile":95.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"89","median_amount":57.19,"10th_percentile":14.86,"90th_percentile":157.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"284","median_amount":43.19,"10th_percentile":17.37,"90th_percentile":104.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"783","median_amount":86.82,"10th_percentile":21.32,"90th_percentile":229.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":43.16,"10th_percentile":11.12,"90th_percentile":108.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":120.0,"10th_percentile":120.0,"90th_percentile":120.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":62.34,"10th_percentile":62.34,"90th_percentile":62.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"1 through 10","median_amount":340.0,"10th_percentile":340.0,"90th_percentile":340.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":631.75,"10th_percentile":631.75,"90th_percentile":631.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":883.94,"10th_percentile":883.94,"90th_percentile":883.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":284.31,"10th_percentile":284.31,"90th_percentile":284.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":292.95,"10th_percentile":292.95,"90th_percentile":292.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"16","median_amount":63.98,"10th_percentile":63.98,"90th_percentile":63.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":146.98,"10th_percentile":146.98,"90th_percentile":159.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"127","median_amount":134.0,"10th_percentile":134.0,"90th_percentile":543.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"138","median_amount":116.1,"10th_percentile":103.3,"90th_percentile":116.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"13","median_amount":670.0,"10th_percentile":670.0,"90th_percentile":670.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"47","median_amount":62.12,"10th_percentile":62.12,"90th_percentile":62.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"33","median_amount":118.47,"10th_percentile":112.43,"90th_percentile":118.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"548","median_amount":670.0,"10th_percentile":390.0,"90th_percentile":670.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"82","median_amount":249.91,"10th_percentile":152.88,"90th_percentile":262.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":41.41,"10th_percentile":41.41,"90th_percentile":41.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"35","median_amount":116.1,"10th_percentile":92.18,"90th_percentile":116.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":62.12,"10th_percentile":62.12,"90th_percentile":62.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":177.71,"10th_percentile":158.12,"90th_percentile":194.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":65.23,"10th_percentile":65.23,"90th_percentile":65.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":112.54,"10th_percentile":112.54,"90th_percentile":112.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"33","median_amount":117.26,"10th_percentile":93.1,"90th_percentile":117.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"106","median_amount":420.0,"10th_percentile":210.0,"90th_percentile":420.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Medicine","code_information":[{"code":"N809","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":337.64,"10th_percentile":337.64,"90th_percentile":337.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":142.37,"10th_percentile":142.37,"90th_percentile":142.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":63.98,"10th_percentile":63.98,"90th_percentile":63.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"46","median_amount":166.83,"10th_percentile":74.8,"90th_percentile":629.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"1 through 10","median_amount":242.0,"10th_percentile":172.0,"90th_percentile":550.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"15","median_amount":62.12,"10th_percentile":62.12,"90th_percentile":62.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"148","median_amount":475.0,"10th_percentile":242.0,"90th_percentile":780.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":305.76,"10th_percentile":208.6,"90th_percentile":737.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":62.12,"10th_percentile":62.12,"90th_percentile":117.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":65.23,"10th_percentile":65.23,"90th_percentile":65.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":231.53,"10th_percentile":231.53,"90th_percentile":231.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"21","median_amount":358.05,"10th_percentile":87.95,"90th_percentile":420.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Packaged Services","code_information":[{"code":"N902","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":987.71,"10th_percentile":987.71,"90th_percentile":987.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":21.58,"10th_percentile":21.58,"90th_percentile":21.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Not Recognized by OPPS","code_information":[{"code":"N905","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":363.63,"10th_percentile":363.63,"90th_percentile":363.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 56] [Cardiac Cath ($): 7000] [Joint Replacement-Full/Partial ($): 16000] [Observation ($): 3091] [Emergency Department (%BC): 56] [Sleep Studies-Attended ($): 1152] [Sleep Studies-Unattended ($): 435] [CT Scan OP ($): 1339] [MRI OP ($): 1814] [Positron Emission Tomography ($): 2376] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [Mental Health (%BC): 56] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 21.9] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":2013.95,"10th_percentile":953.06,"90th_percentile":2013.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 40 Maximum Reimbursement 3450 Charge Threshold 3450 (%BC): 11] [Observation (%BC): 50 Maximum Reimbursement 3181] [Occupational Therapy (%BC): 60.7] [Physical Therapy (%BC): 60.7] [Respiratory Services/Therapy  (%BC): 60.7] [Speech Therapy (%BC): 60.7] [Other Outpatient Implant ($): 0 Charge Threshold 7798 (%BC): 22.3] [All Other OP (%BC): 60.7]","count":"1 through 10","median_amount":4765.32,"10th_percentile":4765.32,"90th_percentile":4765.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":353.04,"10th_percentile":353.04,"90th_percentile":353.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50 Maximum Reimbursement 5150 Charge Threshold 5150 (%BC): 12] [Observation (%BC): 50 Maximum Reimbursement 3100] [Occupational Therapy (%BC): 53.5] [Physical Therapy (%BC): 53.5] [Respiratory Services/Therapy  (%BC): 53.5] [Speech Therapy (%BC): 53.5] [Other Outpatient Implant ($): 0 Charge Threshold 7800 (%BC): 25] [All Other OP (%BC): 53.5]","count":"23","median_amount":4765.32,"10th_percentile":4717.34,"90th_percentile":4864.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56.6 Maximum Reimbursement 11000] [Cardiac Cath (%BC): 56.6] [Joint Replacement-Full/Partial ($): 16000] [Observation (%BC): 56.6 Maximum Reimbursement 3404] [Emergency Department (%BC): 56.6] [Nuclear Medicine (%BC): 40] [CT Scan OP ($): 800] [MRI OP ($): 1250] [Positron Emission Tomography ($): 3000] [Radiology (%BC): 40] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 1500 (%BC): 60] [All Other OP (%BC): 56.6]","count":"1 through 10","median_amount":1702.47,"10th_percentile":1702.47,"90th_percentile":1702.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Countycare Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":353.04,"10th_percentile":353.04,"90th_percentile":353.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Centene Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2648] [Cardiac Cath ($): 6855] [PTCA w/ Drug Eluting Stent ($): 19704] [PTCA w/non Drug Eluting Stent ($): 15528] [PTCA w/out stent ($): 10534] [Observation ($): 4055] [Emergency Department (%BC): 40] [Critical Care (%BC): 60] [Urgent Care ($): 223] [Cardiac Rehabilitation Therapy (%BC): 60] [Cardiac Stress Test (%BC): 60] [Cardiology (%BC): 60] [Echocardiology ($): 2166] [EKG/ECG  (%BC): 60] [Holter Monitor/Telemetry (%BC): 60] [Peripheral Vascular Lab (%BC): 60] [EEG (%BC): 60] [EMG (%BC): 60] [Neuropsychological Testing and Biofeedback (%BC): 60] [Sleep Studies (%BC): 60] [Chemotherapy (%BC): 60] [Nuclear Medicine ($): 689] [Oncology (%BC): 60] [Radiation Therapy ($): 1011] [CT Scan OP ($): 1115] [MRI OP ($): 1980] [Imaging Services (%BC): 60] [Mammography-Diagnostic ($): 194] [Mammography-Screening ($): 194] [Positron Emission Tomography (%BC): 60] [Radiology ($): 482] [Ultrasound Imaging ($): 740] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 60] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 60] [Occupational Therapy ($): 214] [Physical Therapy ($): 214] [Respiratory Services/Therapy  (%BC): 60] [Speech Therapy ($): 214] [Mental Health-Intensive ($): 250] [Mental Health-Partial Hospitalization ($): 443] [OP ECT Mental Health ($): 805] [OP High Cost Drugs ($): 0 Charge Threshold 3750 (%BC): 44] [Other Outpatient Implant ($): 0 Charge Threshold 5000 (%BC): 44] [Ambulance--Air  (%BC): 60] [Ambulance--Land  (%BC): 60] [Hyperbarics (%BC): 60] [Pulmonary Function (%BC): 60]","count":"1 through 10","median_amount":2148.0,"10th_percentile":2148.0,"90th_percentile":2148.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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